Rethinking the Blow Job: Condoms or Gonorrhea? Take Your Pick

Gonorrhea — also known as “the clap,” possibly because doctors used to believe the sexually transmitted infection was treatable by slamming a heavy object down on one’s penis (yes, really) — is the second most commonly reported infectious disease in the United States, after chlamydia. And it’s on the rise, with the CDC reporting more than three hundred thousand new cases each year, because young people are giving head without using any sort of protection. But how can you convince sexually inexperienced youngsters — who are often already nervous about rounding the bases in the “right way” illustrated by porn and pop culture — to use condoms for blow jobs? Like, who does that?

First, a quick gonorrhea FAQ: Most people think of gonorrhea as something that festers down below, but the STI is actually way more likely to get passed onto others via the throat, particularly through blow jobs. (Kissing and cunnilingus don’t spread it because saliva contains enzymes that destroy gonorrhea. Thanks, saliva.) According to statistics from Los Angeles County, the proportion of pharyngeal to genital gonorrhea cases among adolescents has increased sevenfold since 1988, probably because, according to a recent CDC report, almost half of teenagers are engaging in oral sex and “adolescents perceive fewer health-related risks for oral sex compared with vaginal intercourse.” The CDC says adolescents and young adults make up nearly half of all new cases of sexually transmitted disease, even though the group represents only a quarter of sexually active people.

Symptoms of the STI, which run the gamut from burning and pain while urinating to pelvic inflammatory disease, which can cause infertility, can appear 2-5 days after infection, or never — according to Planned Parenthood, eighty percent of women and 10 percent of men with gonorrhea show no symptoms. But gonorrhea is way, way more contagious than HIV: A woman who has unprotected sex with an HIV carrier has about a one-in-a-thousand chance of testing positive for the virus, but a woman who has unprotected sex with a gonorrhea carrier has a sixty-six percent chance of getting infected.

Gonorrhea is, in short, rather unpleasant — and rather easy to catch.

Dr. Magnus Unemo, the head of the World Health Organization’s Collaborating Center for Gonorrhea and Sexually Transmitted Infections, told the New Yorker that, ten or fifteen years ago, experts thought the STI would fade into oblivion, thanks to more prevalent condom usage fueled by the AIDS epidemic and a federally funded gonorrhea control campaign that launched in the 70s. Instead, in 2012, we’re facing a new antibiotic-resistant strain of gonorrhea and what the magazine’s Jerome Groopman calls “the harbinger of a sexually transmitted global epidemic” — and it’s largely due to our cavalier attitude about oral sex.

“The adaptive nature of the gonococcus, coupled with the prevalence of unprotected oral sex, all but insures that drug-resistant gonorrhea will eventually take root in the general heterosexual population,” Groopman warns, adding that “Whatever freedoms were won during the sexual revolution, bacterial evolution promises soon to constrain.”

Well, shit. That sounds horrible. But young people are giving head without understanding the potential repercussions — and also because many would rather take a risk than be awkward or uncool. Is it possible to convince them it’s not totally lame to give head using a condom? And who does actually use a condom for blow jobs? According to multiple surveys, very, veeeery few people.

“My doctor told me I was an idiot for not using condoms during sex, but he never said anything about blow jobs,” said Tim*, a 21-year-old college senior who is fastidious about practicing safe intercourse but not safe oral sex. “It makes me a little nervous [to have unprotected oral sex], but it feels like such a weird thing to ask of somebody, that it isn’t worth it. It’s one thing to put a bagged penis in a vagina, but quite another to make somebody taste latex.”

Indeed. Is there a way to make latex sexy?

Ethan Imboden, founder of “sexual wellbeing” company Jimmyjane, said condoms have a stigma because they are perceived as decreasing pleasure, rendering them majorly uncool. “What would really move the needle would be to create a condom designed specifically for oral sex, that enhances the experience,” he said, adding that he’d love to partner with a manufacturer to develop that line and bring it to market. Until then, he advised “holding a vibrator against your cheek or jaw bone while performing fellatio” to increase sensitivity and checking out Sir Richards and Proper Attire brand condoms, the former for “equal measures of humor and responsibility” and the latter because it “partners with fashion designers to bring style and awareness to condoms.”

But it can be nerve-wracking enough for young people venturing into new sexual territory to broach the condom discussion — can they really be expected to bring up sex toys, too? Carol Queen, Good Vibrations Staff Sexologist, agreed that “pleasure is one of the obstacles to oral barrier use … because so many guys still have the idea that condoms will minimize the sensation they feel,” and had some simpler (and detailed) ideas to increase said pleasure:

A few drops of water-based lubricant inside the condom, before it’s rolled on, make the condom slide across the most sensitive part of the penis – the head – and make the sensation carry much better. It actually even turns the condom into a foreskin-like, slippery membrane that can add pleasure. (if the guy has a foreskin already, BTW, retract it before putting the condom on, otherwise the condom may get scootched off the penis as the foreskin moves.) Note: because oral sex generally lets you keep your hands on the penis, you can safely use more lube in the condom with fellatio than would be safe during intercourse, because the blow job giver can hold the condom on if the threatens to slide off; that’s harder to do with intercourse.

But both Imboden and Queen said the real problem isn’t as simple as creative condom play; it stems from our country’s lamentable abstinence-only sex-ed programs, which have unintentionally popularized the concept of oral sex as a lesser evil. “So many people think [oral sex] isn’t ‘really’ sex,” Queen wrote in an email, “But there are plenty of people for whom oral is a central sex act, and implying it isn’t really sex does them quite a disservice – and may, in a way, encourage people to have oral sex without thinking of it as risky.” Imboden agreed, and said he thought ground-level work would be more effective than trying to push information through the classroom.

One great example of great grassroots sex education is the Bedsider PSA campaign, part of The National Campaign to Prevent Teen and Unplanned Pregnancy. Liz Sabatiuk, the Campaign’s Social Media Manager, said the initiative focuses heavily on STI testing, not just on making condoms seem sexier. One of her favorite tools is qpid, an app that verifies STI results and allows users to privately share them with partners online and via text. All jokes aside about the proper emoticon to use to convey sadness about giving your boyfriend HPV, the app is a fantastic way to — in its own words — make “that, ‘Um, have you been tested?’ conversation easier.”

Sabatiuk stressed the importance of communication in all sexual encounters, oral or otherwise, citing Bedsider’s “Real Story” section, which features videos of young adults speaking honestly about sex. “It’s never been an awkward moment for me,” a 23-year-old woman explains in one video. “I’ve just kinda accepted the fact that I have to use [a condom] in order to be safe and I take it out at the right moment and it’s never been an issue for me.” Sabatiuk said she loved the way the woman in the video frames the prospect of bringing up condoms as “being something she can control that’s necessary in order to be safe applies just as well to oral sex as to ‘regular’ sex,” and that she hoped the videos could encourage teens and young adults to follow her example.

But the 20-somethings I spoke with about the connection between gonorrhea and oral sex didn’t seem swayed by statistics or fancy condoms. (One woman specifically said she would be happy to use a condom while performing oral sex if a partner asked her to but “no flavored condoms, please!”) When I told 22-year-old Stephanie about how easily the STI is transmitted and asked if, armed with that knowledge, she’d be more likely to ask partners to use condoms before going down on them in the future, she said it was “tricky.”

“If I didn’t know the guy, I’d want to protect myself more, but I also wouldn’t want to seem weird,” she said. “Because then he’d probably ask, ‘why?’ and I’d have to explain, and then I’d feel like I was accusing him of having gonorrhea. In my experience, that’s not the standard practice. So it would raise questions.”

What would the experts do in that situation? “I would say that all the same arguments apply in the same way they do when you bring up condoms in regard to sexual intercourse,” Sabatiuk said. “You have to present it as wanting to be safe, wanting to protect your partner, wanting to have a relationship of mutual trust.” She paused and giggled. “That sounds really cheesy, actually.”