Talk:Safe sex/Archive 5

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Practices

Here are two competing versions:

Version 1	Version 2
===Sex by yourself===	===autoeroticism===
Known as autoeroticism, solitary sexual activity is relatively safe. Masturbation, the simple act of stimulating one's own genitalia, is a generally safe sex practice as long the object used for the stimulation, like the hand or a sex toy, is not infected or later used by someone else. Similarly, fluids, specially semen, vaginal fluids and blood carry contamination risks between partners.	Known as Autoeroticism, solitary sexual activity is relatively safe. Masturbation, the act of stimulating one's own genitalia, is safe so long as contact is not made with other people's discharged bodily fluids. However, some practices, such as self-bondage and autoerotic asphyxia, are made considerably more dangerous by the absence of people who can intervene if something goes wrong.
When stimulation of more than one possible infected area is involved, specially the anus before vagina stimulation, masturbation carries a higher risk of cross STD infection.
Modern technology does permit some activities, such as "phone sex" and "cybersex", that allow for partners to engage in sexual activity without being in the same room, reducing the risks involved with a sexual intercourse between partners.	Modern technology does permit some activities, such as "phone sex" and "cybersex", that allow for partners to engage in sexual activity without being in the same room, eliminating the risks involved with exchanging bodily fluids.

With some changes here and there, these two have been edit warred back and forth for no good purpose. Can we work out a third version here that everyone can agree on? That way, when the page becomes unprotected, we'll have one stable, concrete, specific improvement that will only require someone pasting it into place.

Please name things that you like or dislike about either version, and we'll see what we can do. WhatamIdoing (talk) 21:10, 21 September 2009 (UTC)

Sure we can, as long as reliable sources are provided for any of this versions (first, second, third, ...)--Nutriveg (talk) 21:19, 21 September 2009 (UTC)

I'm conflicted, because Autoeroticism gets my vote, as the other one is clumsy, but the term is slightly different from solitary sex - for example, "making a scene with a magazine",Waits, Nighthawks at the Diner (1975) involves an external sex object, but it is not the one making the scene that is the object of erotic fixation, it is the image in the magazine - whereas, using an object like a cucumber for sex in order to stimulate an erotic appreciation of one's own body is (where there is no erotic attraction to vegetables, per se, - such an attraction would be paraphilic rather than autoerotic) . Why not just call it 'solitary sex'. Also, "Autoeroticism" - "Known as autoeroticism" seems a bit pointless when that is the title of the section. So, "Solitary sex" "Such as autoeroticism, having sex alone, having sex with oneself, such as masturbation." would be a start, with WP:RS and/or wikilinks to Autoeroticism and Masturbation, etc. Then the relevant stuff that relates to safe sex. Mish (talk) 23:17, 21 September 2009 (UTC)

What I dislike about the "Sex by yourself" title is that it's a non-encyclopedic grammatical person. WhatamIdoing (talk) 00:49, 22 September 2009 (UTC)

Version 1, paragraph 2 talks about cross infections. I find this statement confusing, because picking up a virus or bacteria from one part of your own body and putting it on another part of your own body does not constitute a new infection. Can someone tell me what the point is here? Has this quit being about 'solitary sex' (or whatever we're calling it) and started being about exchanging body fluids with a partner somewhat indirectly? WhatamIdoing (talk) 06:46, 22 September 2009 (UTC)

Don't know what the source was referring to, but a couple of possibilities:

• The example in the citation sounds like it is talking about transfer of flora/pathogens from the anus to the vagina. (possibly similar to what might occur from improper hygiene - e.g. wiping back to front; maybe Bacterial vaginosis, or other reproductive tract infection, may not be specifically sexually transmitted diseases.)
• Herpes simplex can be spread from one part of the body to another, see Herpes_simplex#The_risk_of_spreading_the_disease. It might also be possible to transfer an HPV infection from one area to another, but I am not aware of references documenting such.

Not advocating for or against said paragraph at this point, just what I would assume it means. Zodon (talk) 09:27, 22 September 2009 (UTC)

Failure to use a barrier and cleansing on sex toys can result in transmission between anus, vagina (and mouth). Don't forget Chlamydia. If I remember right, the Lesbian Good Sex Guide goes into all this stuff, including the risks of vaginosis from transferral of fecal matter to the vagina. Mish (talk) 13:19, 22 September 2009 (UTC)

I don't think these would be considered sexually transmitted diseases, any more than a UTI would be considered an "elimination-transmitted disease" if you smeared feces into your urethra after defecating. Similarly, influenza is not an STI even if you definitely catch it from a sex partner. We don't really need a "health effects of masturbation" section here. WhatamIdoing (talk) 16:00, 22 September 2009 (UTC)

UK List of STIs (note that HIV not included as STI) [1]

• URETHRITIS: Chlamydia, Non-gonococcal urethritis (NGU), Gonorrhoea

• VAGINAL DISCHARGE: Bacterial vaginosis (BV), Candidiasis, Trichomoniasis

• GENITAL ULCERATION: Genital herpes (GH), Early syphilis, Late syphilis, Donovanosis (granuloma inguinale), Lymphogranuloma venereum, Chancroid

• SYSTEMIC PRESENTATIONS AND COMPLICATIONS: Prostatitis, Epididymo-orchitis, Pelvic infection and perihepatitis, Hepatitides A/B/C, Sexually acquired reactive arthritis

• MISCELLANEOUS: Anogenital warts, Molluscum contagiosum, Scabies, Pediculosis, Balanitis

In this context, it does seem relevant, because if we are discussing masturbation and the use of sex toys as potentially safe, then it is important to note that there are implications that relate to 'safe sex' for solitary sexual activity, because infections can still be transmitted from one part of the body to another, and resulting in an STI where there was not one before, or where one that was localised in one area becomes spread to a different area. On the other hand, auto-asphyxiation and self-bondage, whilst being potentially unsafe, seem outside what is usually understood by safe sex (off-topic and original research in this context). You might just as well list self-castration and other forms of genital self-mutilation deriving from autogynephilia and body dysmorphia or gender dysphoria if you are going to include any activity associated with sex that is considered unsafe. Mish (talk) 17:05, 22 September 2009 (UTC)

I believe that "safe(r) sex" is really only used when talking about infections that are transmitted from one person to another, and you haven't produced any evidence that my impression is wrong. For example, excessive masturbation results in chafed skin (which is always an infection risk); this isn't exactly unusual among very young children. But that doesn't mean that the two-year-old with the masturbation-induced chafed skin that's now blossomed into full-blown fungal infection has a "sexually transmitted disease".

"Safe(r) sex" is about "how not to catch a disease from another person". It's not about "how to be perfectly healthy while engaging in sexual behaviors." If it was really about being perfectly healthy, our sources would have large sections dedicated to psychosocial issues like "What if we break up?" and "What if she gets pregnant?" -- and they don't. These obvious and important mental and physical health issues are not a "safe(r) sex" issue.

I think that you're reading far too much into the BMJ list. Hep A is only an STI if you got it from a sex partner instead of from inadequate hygiene; it's commonly a food-borne illness. Pre-pubescent girls turn up with BV fairly often despite zero evidence of sexual activity (including even masturbation, which is fairly uncommon among girls aged 5-10). Most kids in continental Europe catch Molluscum; it's known to be transmitted efficiently through public swimming pools. Only a minority of pediculosis (which is the fancy way of saying "lice") cases have any relationship with sexual activity. And so forth: something that can be transmitted through sex doesn't mean that it's always an STI. (Consider, for example, the many hemophiliacs infected with HIV through blood transfusions.) "Safe(r) sex" will not prevent these infections and infestations.

If you go look at the definitions carefully, you'll see that this clear: a Sexually transmitted disease is "an illness that has a significant probability of transmission between humans or animals by means of sexual contact" -- "between humans" (note the plural), not "from one part of the same person to another part of the same person" or "from the natural environment to a solitary individual that rubbed his penis until it was cracked and raw, causing an infection of the sort that you'd see anywhere you had cracked, raw skin". Safe(r) sex is defined above as "reduc[ing] the risk of contracting and transmitting sexually transmitted infections." You cannot "contract" what you already have, and you cannot "transmit" what you don't have. The medieval notion of spontaneous generation of germs was discarded hundreds of years ago (despite a college student telling me several years ago that he had always believed HIV magically sprang into being if two healthy, uninfected people had sex without a condom -- it was a depressing conversation).

I don't think we can support any of the claims about disease transmission here. A statement that it was possible for a person to cause non-STI harms while engaged in solitary sex (although the named ones are a little over-the-top) is probably supportable. Perhaps, for example, we would refer to a "clean hand or sex toy". WhatamIdoing (talk) 20:20, 22 September 2009 (UTC)

Some STIs easily reach your blood stream so it doesn't matter how one got it, like HIV, other are localized, and can be sexually transmitted from an area of the body to other, increasing the complications or risk of the STD.

Your (not)examples don't fit the definition because the infection wasn't transmitted by sexual activity

The definition you provided for STDs, although from a Wikipedia article, is not sourced.--Nutriveg (talk) 21:19, 22 September 2009 (UTC)

I would change your suggestion from "clean" to "uninfected" since I'm not aware of any cleaning agents approved for that purpose, specially because some virus (like HPV) aren't easily cultured for testing.--Nutriveg (talk) 22:16, 22 September 2009 (UTC)

I agree with Nutriveg's first comment, the 'STD' article has scant sources.

The correct term is not 'STD', which like 'VD' is deprecated and replaced by 'STI'.

The list of STIs I presented includes infections that are transmitted sexually, but which are also transmitted non-sexually and found among children. If we have a section on wanking and other forms of solitary sex, and we present this as being risk free safe sex, when STI's can be contracted without sexual contact with another, then this would mislead people. We are not supposed to present material that is insaccurate and wrong - an STI can be contracted without sexual contact with other people, through forms of autoerotic practice, and so presenting this as 'safe sex' cannot be established in WP:RS - because the opposite is the case. It is only 'safe' if practiced in conjunction with other 'safe sex' practices. We state that it is safe as long as items used have not come in contact with other people's bodily fluids - but this is insufficient, as STIs can be contracted without contact with other people's bodily fluids. That is all I am saying, not that we have to whack-on about this, but in what we say we need to be accurate, and what we have is not accurate - just as including BDSM and stuff is off-topic, because that has nothing to do with 'safe sex' practices. Mish (talk) 22:20, 22 September 2009 (UTC)

Mish, it's more complicated than that. It's an STD if you get symptoms. STIs include all STDs plus all asymptomatic infections. And the terms are "preferred" or "deprecated" not by scientists, but by advocacy/marketing groups. VD isn't "wrong"; it's politically incorrect, in exactly the same fashion that people will scowl if you say that a person is mentally retarded instead of intellectually disabled.

You have failed to produce a single source that says an infection that is not acquired through sexual activity with another person is a sexually transmitted infection. WhatamIdoing (talk) 23:19, 22 September 2009 (UTC)

I see what you are saying, as the sources do seem to discuss infections arising from mutual masturbation and sharing of sex toys, and do not discuss solitary acts. Mish (talk) 00:09, 23 September 2009 (UTC)

My choice:

===Solitary sex===

Known as autoeroticism, solitary sexual activity is relatively safe. Masturbation, the simple act of stimulating one's own genitalia, is a generally safe sex practice as long the object used for the stimulation, like the hand or a sex toy, is not infected or later used by someone else. Similarly, fluids, particularly semen, vaginal fluids and blood carry contamination risks between partners.

Poor sexual hygene, such as stimulating the anus before vagina stimulation, masturbation carries a risk of passing infective material from one orifice to another, including infections classed as STIs (e.g. vaginosis and herpes).

Mish (talk) 00:09, 23 September 2009 (UTC)

That's a reasonable start, and I think it's an improvement over both of the previous versions. I think that the "later used by someone else" is missing the point: The object's later use runs no risk to the first user, and we're writing from the perspective of the first actor. We need to maintain a single perspective here to avoid confusing our readers.

I'm also not sure that the word "simple" belongs in the second sentence. The third sentence might be better written from within this context of the solitary first-actor. That's a lot of little changes, so here's what it might look like all together:

Known as autoeroticism, solitary sexual activity is relatively safe. Masturbation, the act of stimulating one's own genitalia, is a generally safe sex practice as long the object used for the stimulation, like the hand or a sex toy, is not contaminated, such as through previous use by someone else. This can result in exposure to infectious body fluids, particularly semen, vaginal fluids and blood.

What do you think of this?

Also, do you think that phone sex should be included? I could go either way with that.

(On another note, we really need to introduce a health risks section at Masturbation, which doesn't mention either the more common problems (chafed skin) or the rare serious ones (penile fracture).) WhatamIdoing (talk) 03:50, 23 September 2009 (UTC)

(edit conflict)

Mish: I think your second paragraph is poor, if someone's body part is infected by a STI that doesn't necessarily mean poor hygiene, since established infections take at least sometime to clear. A infected object can also contaminate external parts, like the vulva, not only the orifice.

WhatamIdoing: Your sources:

"Condoms should be used consistently and correctly when using sex toys"

"our findings raise the possibility of transmission by finger-genital contact".

"Hands may also serve as reservoirs of infection in both men and women. Auto-inoculation involving the hands may result from (...) masturbation."

WhatamIdoing: I will discuss your last comments later

--Nutriveg (talk) 03:54, 23 September 2009 (UTC)

Besides the presented sources above I don't think they provide enough balance so far to support that "safer sex" includes the risk of "auto-infection".

However I don't support the removal of "later used by someone else", since PAHO/WAS/WHO definition, the only useful so far, is about "contracting and transmitting".--Nutriveg (talk) 05:14, 23 September 2009 (UTC)

None of these sources have anything to do with safe sex, and thus are either irrelevant or WP:NOR violations.

Can you explain how a second person using the same sex toy at a later time makes the first person sick? WhatamIdoing (talk) 05:59, 23 September 2009 (UTC)

I don't understand your first phrase, I already said that: "I don't think they (those sources) provide enough balance so far to support that "safer sex" includes the risk of "auto-infection"."

About the your second phrase, do you clearly understand the meanings of "contracting and transmitting"? The first person can't contract, but she can transmit. So that doesn't fit PAHO/WAS/WHO definition.--Nutriveg (talk) 06:33, 23 September 2009 (UTC)

@WhatamIdoing. I take your points, but I excluded phone/cybersex as there are no sources for that - also, the text described this in a way that it was not solitary sex. If we include that we start including lap-dancing, sex-booths, and so on. What's the point? It's all wanking in one form or another. Mish (talk) 13:53, 23 September 2009 (UTC)

@Nutriveg, sexual hygene has a different meaning to hygene, and I am unable to see how what you said bears any relation to what it was directed at. As for the rest of your comments, they too are oblique and incomprehensible. Please rephrase saying what you mean in ways we can understand what it is that you are trying to say, and point to what you are referring to in the PAHO/WAS/WHO policy documents. The point about orifices is taken, and this should read 'locations'. Thanks.Mish (talk) 13:53, 23 September 2009 (UTC)

My pointing citing the PAHO/WAS/WHO definition, as they define safer sex, for contracting and transmitting, while WhatamIdoing suggested change as it was just about contracting.--Nutriveg (talk) 15:07, 23 September 2009 (UTC)

Solitary sexual behavior can't transmit a disease to anyone because there isn't an "anyone" to transmit it to.

You have one person in the room: That one person uses a clean sex toy, but does not clean it afterwards. Nobody else gets sick, because nobody else is there.

The next day, a different person comes into the room. That one person sees a dirty sex toy. This proposal already indicates that using dirty ("contaminated") sex toys is unhealthy.

Where's the problem? WhatamIdoing (talk) 23:38, 23 September 2009 (UTC)

That's a hypothesis assuming a minimum time frame between the sharing of sex toys and that infection is easily distiguished. Reliable sources have emphatically recommended not sharing sex toys, without distinction of dirtiness [2]--Nutriveg (talk) 00:36, 24 September 2009 (UTC)

It's not a hypothesis; you can't test what I've written. It's a scenario -- a story. The purpose of the story is to get you to quit thinking in terms of these two unrelated people interacting, because they aren't interacting in any meaningful sense. Not interacting with another is the sole point for this section: it's solitary sexual behavior. You cannot meaningfully discuss solitary behaviors in terms of multiple people.

Put another way: your concern is True™, but irrelevant (for this section). WhatamIdoing (talk) 01:30, 24 September 2009 (UTC)

I have done a bit of tidying up of the text, all explained in the edit header. I doubt I'll be around much for a day or so, so don't expect any responses from me for a while. I had a quick look at Nutriveg's new edit, and I don't see any major problems, although may have tidied up a few bits for readability. I eliminated all the 'shoulds' while I was at it. I agree that the stuff about passing material from the anus during solitary sex is unnecessary, because I have made the anal sex about anal sex and sex toys, and this would cover solitary sex anyway (i.e., we don't need to spell this out). I still think that the section on wanking etc. as a safe sex practice ought to be entitled 'solitary sex', with something that adds that similar precautions with sex toys are taken as with a partner. The stuff about sex toys could be expanded to include lesbian safe-sex practice as well - although running anal sex, sex toys, and lesbian safe sex is stretching things a bit really. I can't find my Lesbian Good Sex Guide, so can't dig out the refs - but the Bullough ref seems to have gone, and it really should be there to cover lesbians. Safe sex doesn't just apply when a penis is involved, although I am sure men find it hard to believe that any sex can take place without one. Mish (talk) 02:52, 24 September 2009 (UTC)

While looking at definitions of safe sex, I found a source (Planned parenthood) that supports the cybersex/phone sex item. Since the main objection to those items that I understood from this discussion was the lack of a source, I restored the item, adding the source. If there were other objections to it, my apologies. Zodon (talk) 07:13, 24 September 2009 (UTC)

I think the sex by yourself title/section is overly restrictive. Sex by yourself seems to imply that nobody else is involved, but there are lots of practices that involve similar levels of risk that involve another person. People can masturbate where they can see and hear eachother - not really by yourself, but still regarded as safe. A title like "Avoiding physical contact" might capture more of the range, or "Avoiding intimate contact," "Not exchanging bodily fluids". Safe options for sexual intimacy include: "Sexual fantasies, massage, hugging, body rubbing, dry kissing, masturbation without contact with partner's semen, vaginal secretions, blood, or broken skin, erotic conversations, books, movies, videos, electronic images, erotic bathing, showering, eroticizing feet, hands, hips, abdomen, ears, other body parts." Marrazzo J, Guest F, Cates W (2007). "Reproductive Tract Infections, Including HIV and Other Sexually Transmitted Infections". In Hatcher, Robert A.; et al. (eds.). Contraceptive Technology (19th rev. ed.). New York: Ardent Media. pp. 499–557. ISBN 0-9664902-0-7. {{cite book}}: Explicit use of et al. in: |editor= (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)CS1 maint: multiple names: authors list (link) Rather than having to have a separate section for low contact items that involve a partner, I think the existing title should be broadened. Zodon (talk) 07:38, 24 September 2009 (UTC)

STI and STD

Mish, you changed the article definition which is still in discussion on this talk page, that's a provocative edit, not a miner one.

You changing all references of "STD" to "STI" isn't also a change that everyone seems to agree, specially where you changed the term used by the referenced source.--Nutriveg (talk) 17:29, 24 September 2009 (UTC)

Zodon, I think your suggested titles (and content expansion) are good; I might prefer "avoiding physical contact" (since HPV and herpes are occasionally transmitted without genital contact). I dislike the current title as being inappropriate for an encyclopedia (which shouldn't address the reader directly). WhatamIdoing (talk) 18:43, 24 September 2009 (UTC)

Nutriveg, while I'm usually a stickler for exactly what the named source says, Mish is not introducing either errors or confusion with the STI/STD change. STI is technically more correct. Furthermore, it's would be confusing to our readers to have us switch between terms in each paragraph for the purpose of perfectly matching the sources. WhatamIdoing (talk) 18:51, 24 September 2009 (UTC)

Well I do think we need to follow the sources since not every infection results in disease. If a source analysed those with a disease and we say that was about infection, that's WP:SYNTH.--Nutriveg (talk) 19:43, 24 September 2009 (UTC)

The change was made in many places. You're complaining about a single ref, but you've reverted 100% of the changes. So which source uses STD instead of STI, and which sentence does that affect? WhatamIdoing (talk) 20:08, 24 September 2009 (UTC)

If I changed a source that used STD with STI, that was a mistake, and that quote should be edited to state STD. The wider change is not problematic - because I gave you an authoritative medical source that stated that STI is preferred usage to STD. STI/STD is a medical term, and the recommended form should be used, unless in quotation. Mish (talk) 20:32, 24 September 2009 (UTC)

WhatamIdoing, I didn't revert STD to STI, I reverted the change in the intro because we are still discussing that definition.

I saw at least one source about partner selection, but It's better to check all of them.--Nutriveg (talk) 20:55, 24 September 2009 (UTC)

You accuse Mish of changing the terms to conflict with "the term used by the referenced source." Tell me which "referenced source" you're accusing her of misrepresenting, or withdraw your apparently false accusation. WhatamIdoing (talk) 23:31, 24 September 2009 (UTC)

I cited where it is and you could have find that, if you had searched instead of assuming bad faith, where you could find as well the new writing that says "organisms that cause STIs to pass through and infect" (so HIV would cause HIV infection). The source is this and now you can assume bad laziness: Staras, A.; Cook, L.; Clark, B. (April 2009). "Sexual Partner Characteristics and Sexually Transmitted Diseases Among Adolescents and Young Adults". Sexually Transmitted Diseases. 36 (4): 232–238. doi:10.1097/OLQ.0b013e3181901e32. ISSN 0148-5717. PMID 19265739.

--Nutriveg (talk) 00:59, 25 September 2009 (UTC)

So the source in question involves a single article (listed five times in the same two sentences), with no indication that the authors intended to use it in its most restrictive definition (that is, to exclude asymptomatic infections), and an official definition (the journal follows Stedmans) of merely "See: venereal disease" -- an indication that your interest in precision is perhaps unwarranted. Although I think it unnecessary, I have no particular objection to following the authors' word choice for this single instance. However, you complained above about 'changing all references of "STD" to "STI"' (emphasis added), not "one". Do you object to any of the other changes, or is your complaint really about this single sentence? WhatamIdoing (talk) 01:17, 25 September 2009 (UTC)

Yes, you are probably right, but the article used STD all the way through, and that is inaccurate. Safe(r) sex is about reducting the risk of sexually transmitted infection. Once the person is infected, then the medical approaches to prevent or treat the onset of sexually transmitted disease step in. Because we are concerned with the avoidance of infection (as a means of reducing infection which leads to disease), we need to ensure that we talk about infection instead of disease. Many authoritative sources use STI, although some do still use STD. So, I guess that if we are going to use safe sex when people use that, and safer sex when they use that, we need to talk about STI as the standard, unless talking about the onset of STD resulting from STI, and unless quoting a source that uses STD. I'm not sure if we should use STD just because a source does when it is talking about infection, but I guess that needs discussion. Mish (talk) 02:11, 25 September 2009 (UTC)

(edit conflict, ansering WhatamIdoing)

Well, it looks someone wasn't satisfied to withdraw the accusation of "false accusation", where that false accusation would be: "you changed the term used by the referenced source".

When I said "You changing all references of "STD" to "STI" " the word "reference" has the meaning of "mentions", the distinction is pretty clear when the whole phrase is read:

You changing all references of "STD" to "STI" isn't also a change that everyone seems to agree, specially where you changed the term used by the referenced source..

But to prove how you're assuming bad faith and you didn't even check, so you don't came again to "accuse me of false accusing" you as well. Looking all those phrases changed from STD to STI that have a citation, I've found two phrases (oooh you'll find another one and I'm "false accusing")

Beyond that which in involves changing "STD in the past year" to "STI in the past year", and you now decide to discuss the author intention, I've found another one:

Where originally "place some teenagers at higher risk of unintended pregnancy and sexually transmitted disease (STD)" became "place some teenagers at higher risk of unintended pregnancy and STIs"

But now, changing what the sources said won't be important neither.--Nutriveg (talk) 02:24, 25 September 2009 (UTC)

Misch, WP:Verifiability is about citing sources, not veracity. WP:MEDRS says we should cite article conclusions exactly. I won't further discuss this issue since I have already informed you.--Nutriveg (talk) 02:24, 25 September 2009 (UTC)

That's fine - now you know how it looks, taking a source that one term is preferable to another, then arguing it applies to the whole article. In this case it was STI over STD, in your case it was 'safer sex' over 'safe sex'. Still, I am sure you will find a way of saying why it is justified in one case and not another (yawn! time for bed). I guess we hang common-sense up at the door for this article, like referring to infections as diseases, and referring to 'safe sex' as 'safer sex' when most people call it 'safe sex' even though some people think it's nasty. Mish (talk) 03:18, 25 September 2009 (UTC)

We are discussing the article title there. I try to follow WP:MEDRS strictly so I wouldn't propose to change the term used by a source while citing it.--Nutriveg (talk) 03:25, 25 September 2009 (UTC)

When you changed the lead opening from 'safe sex' to 'safer sex', that was not about the title, nor was your changing other uses of 'safe sex' to 'safer sex'. You follow WP:MEDRS when it suits you - as for example your proposal below about using a CDC source on condoms to support your views on abstinence when that source does not mention anything resembling what you wrote. No. You have a POV about "safe sex" that relates to "abstinence", and are trying to impose your POV on this article, and using policies like WP:MEDRS to impose your will in a way that does not improve this article, while at the same time trying to insert material that cannot be verified in sources, pretending style guides are authoritative medical documents, dismissing reliable medical sources as 'promotional'. This is all POV pushing, and it has to stop. Safe sex is about people having sex, and the means they take to prevent STI infection - you may not like it that people do that, but that is what they do, and it is called safe sex because that is what it was called historically and it stuck.

Now you start getting all self-righteous and rhetorical because I change references to STIs to STDs? I'm not surprised - STDs sounds much more nasty than STIs, and so using STD fits in with your POV; so there is an issue about neutrality when you use STD to describe STIs. I am fine with the use of STD when appropriate, but the sources need to reflect the usage of STI as well, and only then the text can reflect the source's usage. Why is this a problem? If an article is written searching for papers on Safe(r) sex using STD in the search, the article will be skewed to reflect sources that use STD; if you want to ensure the article covers sources adequately, any references Safe(r) Sex that use STD need to be weighted the same as references to those that use STI. When you have verified those existing sources that used STI rather than STD, and managed to make up any shortfall in this with sources that use STI, then you will be in a position to discuss whether it is best to confuse the reader by using both terms according to how the source uses them (and ensuring that this article will never come anywhere GA status) or figure some other way of handling the divergence in terminology (such as an explanation about the two terms, and our usage, similar to my suggestion about 'safe sex' & 'safer sex', but which you never responded to).

My own view is that when discussing disease, we use disease, and infection infection. Safe sex is about reducing the risk of passing on /contracting infection, as a way of stopping the spread of the diseases that result from those infections. One is what you 'get', the other is 'what happens when you get it'. We are concerned with measures you can take to avoid 'getting it' in the first place, so we should be more interested in STI-related material than STD-related material. Mish (talk) 11:02, 25 September 2009 (UTC)

Please don't duplicate discussions, discuss those issues in the sections they are already being discussed.--Nutriveg (talk) 11:09, 25 September 2009 (UTC)

No, I don't think so - you need to be made aware of this hypocrisy. Mish (talk) 11:19, 25 September 2009 (UTC)

Don't [change your comment after] someone already answered it. I've already pointed my concerns about those STD to STI changes without checking the source that supported the text, so I don't have much more to talk about this, even tough you didn't fix that edit yet. Personal attacks won't help here.--Nutriveg (talk) 11:41, 25 September 2009 (UTC)

It was an edit clash - I was changing the format in fairly trivial ways while you made your entry - you didn't answer it, you avoided answering it, so this is an irrelevant comment. Stop telling people what to do. Mish (talk) 11:51, 25 September 2009 (UTC)

thanks for pointing this out, looking at the source and the text inserted into the article, it is clear that this is not a quote, yet it reproduces a section of text from the source intact. That is called plagiarism, and is a very serious breach of policy. I have re-written it in a way that it no longer plagiarises the the source: if you inserted this text, then please ensure that you do not plagiarise sources again in the future, and check thoroughly that any other material you have inserted does not plagiarise sources, otherwise you will be reported for this. Mish (talk) 12:04, 25 September 2009 (UTC)

Abstinence and safe sex - typical effectiveness

The following addition to the section on abstinence was removed without explanation, except (in one case) for the claim that it did not have a source (which it does).[3] Why was it removed?

• Long term abstinence is difficult to maintain - those intending to be abstinent may not follow through with that intention, thus when studying or advocating abstinence as a form of safer sex, it is important to consider the failure rate in typical use.<ref>Fortenberry, J. Dennis (2005). "The limits of abstinence-only in preventing sexually transmitted infections" (PDF). Journal of Adolescent Health. 36 (4): 269–270. PMID 15780781. Retrieved 2009-09-09. {{cite journal}}: Unknown parameter |month= ignored (help), which cites:

Pinkerton, SD (2001). "A relative risk-based, disease-specific definition of sexual abstinence failure rates". Health education & behavior. 28 (1): 10–20. PMID 11213138. {{cite journal}}: Unknown parameter |month= ignored (help)</ref>

Note: When copying it here I updated the citation with full citation template, whereas before it just had link to the article. Zodon (talk) 06:07, 24 September 2009 (UTC)

It was removed because the last stable version (from September 7) was restored.

I suggest this other text:

Refraining from any sexual contact with another individual is the surest way to avoid the risk of sexually contracting STDs.<ref name="CDC condoms"/> In that context complete sexual abstinence,<ref name="CDC condoms">"Condoms and STDs: Fact Sheet for Public Health Personnel". Centers for Disease Control and Prevention. July 15, 2009. Retrieved 2009-09-13.</ref> like autoeroticism, is one of those practices that fit that definition.

However, sexual abstinence is seen by critics as repressive, it is difficult to maintain for prolonged periods of time and practitioners may restrict the abstinence only to specific sexual practices they see associated with increased STD risk or with other purposes of sexual abstinence, like contraception and some definitions of virginity. Thus when studying or advocating abstinence as a form of safer sex, it is important to consider the failure rate in typical use.<ref>Fortenberry, J. Dennis (2005). "The limits of abstinence-only in preventing sexually transmitted infections" (PDF). Journal of Adolescent Health. 36 (4): 269–270. PMID 15780781. Retrieved 2009-09-09. {{cite journal}}: Unknown parameter |month= ignored (help), </ref>

Please let me know what should be changed in that.--Nutriveg (talk) 10:10, 24 September 2009 (UTC)

The first paragraph does not relate to the source in any recognisable way, because what it says is not in the source. The second parapgraph does not reflect the content of the source accurately. Fortenberry does not refer to abstinence as repressive, nor to critics as saying this, so that statement is wrong. What he does say is that abstinence appears logically to be 100% effective, and is implemented as national policy on that basis; however, as a policy program, it is less effective: abstinence initiatives fail when people have sex despite this policy, adolescents do have sex without meaning to, and not having the precaution of carrying condoms puts them at greater risk; this risk carries over into adulthood for those who do not manage to abstain and who do not carry out standard safe sex practices. Mish (talk) 10:25, 25 September 2009 (UTC)

The source clearly says "The most reliable ways to avoid transmission of sexually transmitted diseases (STDs), (...), are to abstain from sexual activity or", if you want another "abstaining from sexual activity (...) is the surest way to prevent (HPV) infection" yet another "CDC supports a comprehensive approach to STD prevention that includes the promotion of abstinence as the surest way to prevent getting an STD", "The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual intercourse, or ". We can change "the surest way" to "one surest way" to reflect better this sources.

The source on the second paragraph is about that last phrase, not the whole paragraph, and I just copied that phrase from Zodon suggestion. If you have a better suggestion for that paragraph please provide it.--Nutriveg (talk) 10:50, 25 September 2009 (UTC)

Abstinence is the surest method, but this fact should be placed in proper context: Most people won't do it if they have other choices, just like most people won't eat the recommended number of vegetables, won't get the recommended level of exercise, won't limit themselves to the recommended level of alcohol intake, and so forth. This is a case where providing all of the information is important. WhatamIdoing (talk) 04:57, 26 September 2009 (UTC)

Been away for the weekend. @Nutriveg. The CDC source on condoms discusses the use of condoms, and mentions the hypothetical lack of risk from abstaining/monogamy. Fortenbury does not talk about abstention as being seen as repressive. Both of these are WP:OR/WP:SYNTH using those sources. Similarly, abstention may be effective in theory, bit in practice, as a strategy, it has its own problems, as discussed in the sources, this needs to be reflected. Suggesting that a strategy for prevention that has its own risks of failure in a way that presents it as reliable is not NPOV. Mish (talk) 20:14, 27 September 2009 (UTC)

True, but we need to be even-handed. The primary reason that condoms don't work for (non-skin-contact) prevention is because people that supposedly "are using condoms" don't use condoms. It's really no different from people saying that they "are using abstention" and then not using abstention. WhatamIdoing (talk) 21:37, 27 September 2009 (UTC)

Dispute resolution

I'm looking at this article's history because an editor requested page protection for an edit war/content dispute.

It was protected on September 20, and it appears the same editors are engaged in the same dispute problems. The article appears to need a lot of work, so I am unclear as to what is the crux of the dispute. Logically, the best strategy to overcome the confusion between editors is to make a concerted effort to improve the article by way of medical texts and public health literature. In my experience on Wikipedia, the most efficient way to overcome a content dispute is to put the most authoritative sources in the article. There is more to argue about when there are missing details and vagaries in the prose. I would suggest asking the earnest assistance of WP:MEDICINE and getting to a med library, then researching the public health publications of English-speaking countries available on the web. --Moni3 (talk) 15:20, 24 September 2009 (UTC)

I completely agree with using the most appropriate sources by WP:MEDRS to solve these issues and presented some of them, but other users give too much importance about their personal opinion to even reject the classification of medicine importance given to this article. :Administration assistance to protect this page was asked because users were reinserting unreferenced text about issues yet in discussion in this talk page, and refusing to remove that change by reverting the edits that tried to restore the text as the previous stable version of this article, from September 7.--Nutriveg (talk) 16:42, 24 September 2009 (UTC)

I understand, but this appears to be similar to an argument about how much to crack the window in a house that is falling down. The stress and effort is misplaced. The article is already incomplete, so what is the harm is letting these edits remain in a poorly written article while you or others construct a better one in a sandbox to replace the faulty one with an article that is superbly written with undeniably excellent sources? I prefer using a sandbox, especially when I rewrite articles that are high-profile, or have been the subject of recent edit wars. This goes with the understanding, of course, that other editors may change some parts of the rewritten article for clarity or prose issues, and further discussions can take place on the talk page about other article issues. --Moni3 (talk) 17:18, 24 September 2009 (UTC)

I go along with that. I am new to this article, but it has some problems, and re-developing in a sandbox will take the heat out, and allow for discussion in a way that hasty POV edits on a live article preclude. I also agree that this should be referred to medicine, but also sexology, for expertise. I shall place the appropriate tag (unless it has been protected again already). Mish (talk) 20:14, 24 September 2009 (UTC)

GrahamColm (talk · contribs) was very helpful when I was constructing the health section of the Lesbian article. I did most of the searching for sources, but he suggested a few and gave invaluable assistance in how to word issues so they are accurate. He is, I believe, a microbiologist. I see the expert template on the article, but I wonder if that's premature. Surely it takes no expertise to read textbooks or websites from authoritative public health agencies, which should be the first steps in improvement. --Moni3 (talk) 20:27, 24 September 2009 (UTC)

I thought that is what you meant when you suggested seeking assistance. The problem is that this is sexology and reproductive medicine, and it is not clear that 'safe(r) sex' is defined as a medical term - it is used in public information texts and policy statements, with both usages, as well as in academic and research papers, with both usages, but one editor seems to be insisting that only one usage is correct, and all the other usages are errors (even though 'safe sex' occurs more frequently than 'safer sex'). How else do we resolve this, if the one user is unwilling to accept other editor's willingness to accept both terms, in favour of the one term based on policy directives/lexicons of three or four interrelated international organisations all under the UN/WHO, yet not reflected in ICD.10? Mish (talk) 00:36, 25 September 2009 (UTC)

I'm not sure I understand your point. How is safer sex not a medical topic? This article discusses the spread and prevention of diseases. Public health and epidemiology are certainly medical topics, and transmission of viral or bacterial agents falls within the scope of WP:MEDICINE. My point, however, above all, is that instead of arguing about that stuff that is being argued about, it does not seem as if the contributors to this article have gone to the authoritative sources, which are medical textbooks and websites for the Centers for Disease Control, European Centre for Disease Prevention and Control, Health Protection Agency (UK), and Public Health Agency of Canada.

This is what will tell you which terms are accepted where. Go with WP:WEIGHT here. Use the term most often employed by English sources. If both are used equally, put it in a note at the bottom of the article to state the term is used in multiple countries. It could be that an entire section needs to be written on what to call this thing, but you won't be able to ascertain that until better sources are used. --Moni3 (talk) 13:06, 25 September 2009 (UTC)

That is not what I said. Safe sex is a sexual practice recommended by some medical authorities, but it does not get defined in the way that medical terms are usually defined. Surgical procedures, diagnoses, anatomy, medicine, therapeutic techniques are all defined technically, and there are standard terms used that the MEDMOS requires be used. Safe sex is not such a term, even though it is referred to in a medical context. It is a bit like arguing whether 'washing hands' or 'hand cleansing' should be used become some medical sources say people should wash their hands and others they should cleanse them. We have been to the WHO, DoH, NHS, CDC, ICD.10, etc., but many agencies seem to avoid using these terms, prefer one term, or use both. Mish (talk)

Moni, I've been tried to use such kind of sources as also defined in WP:MEDMOS article naming conventions and WP:MEDRS ideal sources, as it can be seen in Talk:Safe sex#New article title but other editors are choosing other approaches to destabilize the discussion by those guidelines.--Nutriveg (talk) 13:34, 25 September 2009 (UTC)

(outdent) @Nutriveg, if you expect people to speak to you without accusation, then try doing this yourself.

@ Moni, addressing your suggestion, these reflect what I have already found:

• CDC - uses both (does have a specific page on 'safer sex')
• ECDC - uses neither
• HPA - uses both
• PHA (Canada) uses both

Where 'safe sex' is used, it tends to describe the practice of safe sex at an individual level. Where 'safer sex' is used, it tends to describe the epidemiological approach which is applies to an individual level (such as the CDC page describing 'safer sex': [4]). This is part of the problem, these agencies tend to describe 'safer sex' in terms of policy, terminology guidelines, epidemiological approach, but 'safe sex' is used when describing it as sexual practice. One user is arguing that only 'safer sex' should be used on this basis, which would change the article significantly, and potentially eliminate material about 'safe sex'. Other editors, myself included, argue that because both forms are used, then there is no reason to enforce the use of one term in preference to the other (common term).

Perhaps this needs to be broken into two articles, one on 'safe sex' practice, and one on 'safer sex' policy and epidemiological initiatives? As it seems they are intended for use in different contexts, with different meanings, even though they are often used interchangeably. Mish (talk) 13:50, 25 September 2009 (UTC)

Mish, you're right about who uses which term preferentially, but there aren't any sources that say that public health policy groups and advertising campaigns (particularly HIV-connected campaigns) prefer "safeR sex" and that everyone else uses "safE sex". It's true -- I see exactly what you do -- but it's not WP:Verifiable, and to include our own analysis of this point would violate WP:NOR.

This article can, I think, comfortably cover both the "practices" and the "social history." I wouldn't bother splitting it (at this time). WhatamIdoing (talk) 04:38, 26 September 2009 (UTC)

The Oxford English Dictionary uses this: safe sex n. orig. U.S. (a) a substitute for or alternative to sexual activity (in later use with conscious reference to sense safe edge n. (b) at Special uses 2); (b) (also safer sex) sexual activity in which the risk of unplanned pregnancy or (in later use esp.) of contracting a sexually transmitted infection (esp. HIV) is minimized, typically by using a barrier method of contraception or by avoiding penetrative sex.

I do not find the term in Stedman's Medical Dictionary, but the American Journal of Public Health uses the term extensively, and I'd like to get hold of a 1987 article in the New England Journal of Medicine titled "What is safe sex?" Answering these basic questions will dictate what issues are in the article. I did not know the name itself was unclear or colloquial and that the term lies almost entirely within public health instead of medicine. These issues should be addressed in the article. --Moni3 (talk) 14:10, 25 September 2009 (UTC)

Yes, I found a number of dictionaries define 'safe sex', but not 'safer sex', although one points out some authorities recommend the more accurate 'safer sex' within its definition (quoted further up the page). However, Oxford and other dictionaries were dismissed by Nutriveg as they were not reliable sources under WP:MEDMOS. He also dismissed the NHS source as reliable despite them being listed as an example of a reliable source, because the material was aimed at the public, and therefore 'promotional'. My advice would be not to seek out a 1987 source, because he will not accept on the basis that is twenty years old and out of date. Mish (talk) 14:48, 25 September 2009 (UTC)

I have been discussing this with people I know who work in HIV and STI health promotion, and they do stress that the only safe sex is no sex or masturbation, and that safer sex is more accurate when talking about sexual practice, but this is in how they describe practices, not as definitions. It strikes me that the article could be broken up into three key sections: Unsafe sex, safer sex, and safe sex, which notes that what people often call safe sex is safer sex, and safe sex is solitary or no sex. Mish (talk) 14:48, 25 September 2009 (UTC)

Mish, this isn't a "wrong" idea, exactly, but it's not verifiable, and therefore we can't use it. The vast majority of sources using "safe sex" are talking about risk reduction, not risk-free behaviors. Only a tiny fraction of sources try to make these terms mean different things. Even the UNAIDS document doesn't say that "safe sex" is risk-free; it only says that someone might misunderstand that term as meaning that it meant risk-free. (Their definition also includes an obvious error: HIV cannot be transmitted between from one person to another if neither of them are infected, even if they don't know their serostatus. There's nothing magical about "know[ing] their HIV-negative serostatus.") WhatamIdoing (talk) 04:33, 26 September 2009 (UTC)

As the term "safe sex" was created in the late 1980s to address the issue of HIV infection, I don't understand why sources from the late 1980s are irrelevant. They are very relevant. Particularly the New England Journal of Medicine, that defines in the title what safe sex is. How is it not relevant to cite how a very authoritative source defined the term when it was introduced? I'm asking this generally, not specifically of you, Mish.

If the article is to be titled Safe sex or Safer sex with the alternate in the first line of the article, is it not the next step to adhere to what sources say about Safe sex/Safer sex? If sources say that this is a term used by Public Health authorities primarily in the US to address the spread of sexually transmitted diseases and prevention of pregnancy, then that is what should be covered. If there is a better, more comprehensive term used by medical authorities or Safe sex/Safer sex is a movement in sex education, it should be merged into a comprehensive article.

What does promotional mean? Advertising? Is that not a bit what public health organizations do? Advertise to the general public how to keep from getting sick? Yet they do it with medical knowledge. --Moni3 (talk) 15:03, 25 September 2009 (UTC)

If the discussion will continue this way, discussing the article title, than we should discuss this in that section, where those arguments were presented.

But to add some little context:

WP:MEDMOS#Naming conventions says:

"Where there is a dispute over a (article title) name, editors should cite recognised authorities and organisations"

I've already cited such for instance clearly supporting the "safer sex" term.

I didn't say NHS was unreliable but that the website Mish was trying to use, "NHS Choices" a "service is intended to help you make choices about your health" was less reliable under WP:MEDRS definition: "public guides and service announcements, which (...) are generally less authoritative than the underlying medical literature." But that discussion is useless since those site citations supported more the "safer sex" term.

Dictionaries don't fit the WP:MEDRS less yet when compared to what that guideline defines as ideal sources, "position statements from nationally or internationally reputable expert bodies" that were the kind of sources I provided.

Beyond that WP:MEDMOS said "where there is a dispute over a name, editors should cite recognised authorities and organisations" where I don't see those dictionaries as such, or at least way bellow the level of the major world health organizations I cited.

It should be noticed that the term "safe sex" is a old term, that according to sources, has been superseded by "safer sex" since the mid-80s. So getting dictionaries and sources from that time won't help to find the current use as requested by WP:MEDMOS#Naming conventions.

I hope we can continue this discussion in the [Talk:Safe sex#New article title|appropriate section]] and I expect you to read that discussion for yourself instead of relying solely on Mish views.--Nutriveg (talk) 15:42, 25 September 2009 (UTC)

My initial comment in responding to the request for page protection focused on the lack of sources used in the article. This still applies, and the argument still surrounds what to call this article when sources are lacking, again making my metaphor about arguing about the cracked window in a house that's falling down appropriate. Constructing the article is not impossible to do, and will not be accomplished by arguing. The effort and stress about the name and what sources are reliable and on and on will only be taken care of by a review of medical and public health literature. The more this is put off, the higher the possibility will be that arguing will intensify. --Moni3 (talk) 16:25, 25 September 2009 (UTC)

As I said there's a separate discussion about the article title, by WP:MEDMOS and WP:MEDRS, not about the "lack of sources used in the article"--Nutriveg (talk) 17:04, 25 September 2009 (UTC)

I got that. I was addressing that point. Any discussion will continue not to bear fruit until you and/or other editors go to the library. It should be graphed or given some kind of mathematical formula: for about 90% of disputes the longer arguments go on and intensify is directly correlated to the lack of sources in an article. --Moni3 (talk) 17:13, 25 September 2009 (UTC)

Thanks, this reinforces what I suggested in the appropriate dicussion, that until we find reliable authoritative medical sources on this, or gain input from an expert in this field, we cannot definitively determine this. So, there is not point arguing that this change is necessary, and change not justified until we have the information. Mish (talk) 18:24, 25 September 2009 (UTC)

Moni, it wasn't clear you were talking about that title discussion.

I would like to know what's the problem you see with these sources: (PAHO/WAS/WHO)[5] and UNAIDS[6]. Thanks.--Nutriveg (talk) 19:46, 25 September 2009 (UTC)

We have been through this. You have two documents, neither are medical sources, one is a writers style guide, the other a strategy document; I have already pointed out that within these organisations, both forms are used - which you explain as 'mistakes' (but have no evidence for that). There are other sources that use both forms, and sources that use the other form, medical organisations, but you don't accept these. In a situation where the sources use different terms, you cannot insist on a single term, on an arbitrary basis. For example, these define and describe "safe sex", not "safer sex"

• Medline Plus, NIH Medical Dictionary. 2009 [7].
• AAARP. 2009. [8]
• The Online Medical Dictionary. http://medical-dictionary.thefreedictionary.com/Safe+sex+guidelines.

Here are the first main relevant examples from a search of Google Books, using "safe sex guidelines and definition" and "safer sex guidelines and definition as the search key.

Use only "Safer Sex"

• The Kinsey Institute new report on sex: what you must know to be sexually literate, June Machover Reinisch, Ruth Beasley, Debra Kent, 1990. "Safe Sex"

Use only "Safe Sex"

• Homosexuality and the Law: A dictionary, Shuck Stewart. 2001.

Use "Safe Sex" and "Safer Sex"

• The guide to living with HIV infection: developed at the Johns Hopkins AIDS clinic, John G. Bartlett, Ann K. Finkbeiner, Johns Hopkins AIDS Clinic, 2001.
• The Complete Guide to Safer Sex, Institute for Advanced Study of Human Sexuality, 1999.
• The Complete guide to safe sex, Ted McIlvenna, David Lourea, C. Moser, Rubenstein. 1987.
• AIDS--responses, interventions, and care, Peter Aggleton, Graham Hart. 1991.
• Love in the time of HIV: the gay man's guide to sex, dating, and relationships, Michael Mancilla, Lisa Troshinsky, 2003.

They do not show that "safe sex" has been replaced, but that both terms are more likely to be used, described or defined - which confirms the search under Scholar which was dismissed as WP:OR by you (Nutriveg). One of these sources is the Johns Hopkins. Mish (talk) 21:57, 25 September 2009 (UTC)

Hello? I was asking Moni about what she thinks about those sources, since she said we should look for more and I would like to hear from her if she thinks that's the wrong way (and why). If you want to discuss the article title use that specific section you abandoned arguing lack of medical related sources.--Nutriveg (talk) 22:20, 25 September 2009 (UTC)

You know what? If no one cares about editing this article by the sources, as WP:MEDRS, I won't care neither, but I don't know how I would edit it other way, so do whatever you want with this article, I won't be here to watch.--Nutriveg (talk) 00:34, 26 September 2009 (UTC)