This year, 4,375 Canadians will be diagnosed with HPV-related cancers, according to last month's Canadian Cancer Society report—a 16 percent increase since 2012. And while cervical cancer used to be the most prevalent HPV-related cancer, it has now been surpassed by oral cancer, which affected men 4.5 times more than women in 2012, and continues to rise.
In fact, HPV expert Gillian Knight of Derby University in the UK says, "All STIs have increased." While it's been drilled into everyone's head by now to use condoms when having penetrative sex, few seem to be having safe oral sex—even as we start to realize the stakes are higher than we once thought.Anisha Gupta is a fourth-year dentistry student at King's College London. Both as an oral health student and as a bisexual woman, she thinks about safe oral sex. Millennials are "the gayest generation ever," she says. Ten percent of 18-to-34-year-old Canadians identified as LGBT in 2012, double that of any other demographic. People are more open to experimentation, Gupta says, and there is an array of "sexualities where penis-vagina sex isn't the only sexual activity." In general, we are having more sex with more partners than ever before, says Knight—but this leaves us more exposed to STIs.
Safe oral sex isn't a priority for most people, says Alex McKay, director of the Sex Information and Education Council of Canada (SIECCAN), because it's seen as a low-risk alternative to vaginal or anal sex. "Most people don't use a condom for oral sex," says Knight. When it comes to cunnilingus and anilingus, the oral dam (the recommended method of protection) is so unpopular it borders on the obscure. But stats like those from Canada show it's time to reconsider the risks we take with oral sex.
Eszter Mucsi, who volunteers at a sexual health resource centre in Toronto, says oral dams are often recommended in a "weird you-should-use-this, but-I-don't-use-it" way. We need a better alternative—one that people actually want to use. And it seems like Gupta, along with her dentistry classmate Carly Billing, and dentist-come-artist Kuang-Yi Ku may have finally come up with it. In a pop-up exhibition at the Science Gallery London earlier this month, they showed one they had designed that doubles as a protective barrier and a sex toy. It's a hands-free mask, with a textured centre which acts as a barrier during sexual contact—think of it as a ribbed condom for your mouth.
So what exactly are the risks from oral sex? Many STIs, like HIV, don't transmit easily through oral sex, says McKay (though the risk goes up with factors like cuts or menstruation, Anisha explains). "But there are some STIs where oral sex is the main [way of] transmission," says McKay. The two STIs most likely to be transmitted through vaginal and anal licking are herpes and HPV (and you can also contract both from fellatio).
Oral sex can spread HPV to the oral cavity, the genitals, and the anus. According to Oral Cancer Canada, HPV causes up to 70 percent of all oral cancers. HPV is "very easy to pick up," Knight says, because it's spread through touch rather than bodily fluids. It's difficult to detect and treat in healthy individuals unless they have developed warts. Except for cervical smears for women, there is no routine HPV screening in any country. There are more than 100 strains of the virus, and some are likelier to develop into cancer.
Some countries, including Canada, have adopted gender-neutral HPV vaccination (Grade 7 students get free HPV vaccines), which protects against some high-risk strains. The bad news, according to the experts, is that you will most likely get some strains of HPV simply by virtue of being sexually active. Around 75 to 80 percent of all people will at some point be infected by HPV. The good news is that these infections usually clear by themselves, Knight says—it's when they don't that they can cause cancer. But the more sexual partners you have, the more types of HPV you are exposed to, and the more at risk you are that one might develop into cancer. You are three times likelier to get oral cancer if you have had more than six oral sex partners (compared to more than 26 vaginal sex partners), Anisha explains, quoting a 2007 New England Journal of Medicine paper.
Clearly, we should be more careful with oral sex—but while safer blowjobs are as easy as using a condom (whether people will actually do that is a different, likely implausible story), most straight people don't even know what oral dams are.
Gupta explains they're essentially the same "sheet of rubber" she uses in her dental practice: "We use it to isolate the tooth [we're treating]." The only difference is that those marketed for sex are not called "dental," but rather, "oral" dams, and they are slightly thinner and bigger—otherwise, they are about as sexy as going to the dentist. They are made from the same latex rubber as condoms, but they are not as widely available in stores. "You can find them online, McKay says. Or you can DIY them by cutting open an unlubricated condom. Talk about spontaneity.
The inspiration for the design they debuted at the Science Gallery London pop-up came from Southeast Asia, Gupta says, where surgical masks worn for pollution have become a fashion statement. The three want to transform the idea of a protective barrier from a necessary evil to something that queer women in particular can embrace as an identity statement. Their prototype masks have black lacy trim and pink lip stencils, so they look like sex toys rather than medical equipment. Gupta says they wanted it to be something you could put in your pocket, just like a condom: "Disposable, single-use, cheap."
Putting on the mask could be the equivalent of putting on a condom—when I tell her about this new design idea, Muczi says she could see it become "a part of the act, another step, as opposed to having this piece of latex flopping around!" But she also thinks that another reason why popularizing barrier protection is so tricky has to do with our difficulty talking about sex—especially with dams, which aren't popular or commonplace.
Talking to friends about safe oral sex, Gupta realized that the information provided was conflicting. Sometimes dams are not even mentioned—but even when they are, using them effectively is not self-evident. "If you're not using [them] correctly it's kind of pointless," she says, adding that the instructions they come with are "unhelpful at best." Anisha explains that you have to place the dam on your partner's genitals (or anus) to create a barrier, and use your hands to hold it in place. You also have to make sure you don't accidentally flip it over. All in all, it can be a bit of a mood killer.
Kuang-Yi, the artist with whom Gupta collaborated, says he wants to break down scientific barriers and communicate with people directly. The three dentist-designers hosted two workshops where they showed people how to make a personalized blowjob-enhancing mouthguard, and encouraged visitors to give their sexual imagination free rein, showing them how dentistry could realize these fantasies. Their design idea doesn't just make safe oral sex more fun—it turns it into a talking point and normalizes it.
Cristina Roca is a culture and lifestyle writer based in Barcelona.