Frankly, we do give a dam: differentiating between dental dams and sex dams

An alert public health official in Winnipeg pointed out that my post on oral sex barriers failed to distinguish between dental dams and sex dams. I freely admit to having been vague on the distinction between the two, this not being an area of expertise for me. So I delved a little more deeply into what the web could offer. Because the primary literature is so focused on condoms (male or female), the web is often the only resort for the safer sex researcher. When you consider the popularity of oral sex in the general population and the clear documentation on disease transmission by means of oral-genital or oral-anal contact, it is surprising and distressing to see so little research.

Try a search in Scopus, for example, on “sex dams.” 15,000 journals and not a single mention. One fares a little better with the search term “dental dams,” until it becomes clear that all the serious research strictly involves their use in dental practice.

Differentiating the dams

In my defence I should say that the term “dental dam” is frequently used to refer to any patch of latex, polyurethane or polyethylene used for oral stimulation during sex. Many safer sex web pages use the phrase exclusively, without mentioning sex dams. It is not surprising that this leads to some terminological confusion. Yet there is a notable difference between the two types of dams, and I hope that the following will be a useful clarification.

A dental dam is a small latex patch, normally 5 or 6 inches square, used in dental procedures. A sex dam is a delicate latex sheet, usually 10 by 6 inches, specially designed for oral sex. It is larger and much thinner than a standard dental dam and frequently comes in various colours and flavours. Polyurethane sex dams are also available commercially, but again, don’t expect to find terminological exactitude or you may miss the Hot Dam Banana Flavored Polyurethane Dental Dam when you do a Google search.

Sex dam benefits

The major factors that differentiate the dams are size, look and feel, taste and smell, thickness, and transparency. Sex products need to be “fun,” a basic requirement often forgotten by those whose main concern is to get the science right.

  1. A good sex dam should be large enough to fit over the entire genital or anal area. Normal dental dams or cut-up condoms are really too small for cunnilingus and anilingus, however “approved” they may be as a barrier.
  2. Some condoms have a powdery surface that is not suitable for oral contact, and dental dams are too rubbery and clinical. The tactile sensation involved in using a dam for pleasurable stimulation is important, for the giver as well as the receiver.
  3. Sex dams are usually scented to hide the turn-off latex stench, and flavoured to please the tongue.
  4. Sex dams are also very thin and delicate. They are designed to give pleasure. A good thing, since there is very little pleasure in trying to find and purchase them on the web or in shops. It goes without saying that a thick, podgy slab of latex has all the sex appeal of a placemat.
  5. Finally, the transparency of a dam is an important motivator. We’re talking sex here, after all, not wrapping cutlets for the freezer. One of the reasons that plastic wrap is used at all is that it allows both sexual partners to see the erogenous terrain, as it were. This is a definite plus when it comes to sexual pleasure. A well-designed sex dam should have this characteristic of transparency or at least translucency.

Alternatives to dams

As I explained in my previous post, most of us who might benefit from them do not have easy access to good sex dams. That is why efforts have been made to suggest safe alternatives, even in the face of the overwhelming lack of good evidence as to their efficacy.

SexualityandU.ca, a Canadian safer sex website, has a good definition of the use of what it terms “dental dams” for oral sex, and it has the most reasonable advice I have been able to find for anyone thinking about using plastic wrap as an alternative barrier:

Some people also use non-microwaveable plastic wrap (Saran Wrap®) as dental dams. This has not been studied in depth yet, but there is evidence that non-microwaveable plastic wrap can stop virus-sized particles, which could mean it can prevent STIs. Until this has been studied in more detail, sticking with latex dams or condoms (or even a cut-open latex glove) is probably your safest bet.  However, plastic wrap is certainly better than nothing, as it does provide at least some level of protection against STIs.

CDC would have done well simply to borrow this balanced and objective plain-language explanation for its revised pronouncement of last June on oral sex and HIV risk.

The SexInfoOnline website, maintained by students from the University of California, Santa Barbara, offers well-illustrated instructions on how to make an oral sex barrier using a standard condom. The final photograph shows revealingly just how small a cut-up condom actually is. Although somewhat chaotically organized, SexInfoOnline is an excellent resource. For example, I learned the meaning of “queefing,” a spicy new addition to my vocabulary.

Compare the cut-up condom photo to this illustration of a sex dam found at Sheer Glyde Dams, a U.S. commercial website that is known to ship product to Canada and Australia. The difference is considerable. A dental dam, the kind used by your dentist, is somewhat larger than a sliced condom, but not as large as the typical sex dam produced for sale at sex shops, on commercial websites, and very occasionally at pharmacies.

The best instructions I have seen for constructing an alternative dam from a condom or latex glove can be found at the website of Agence de la santé et des services sociaux de Montréal. The information is available in English and French accompanied by detailed colour photographs. With predictable Canadian reserve, the instructions, thorough as they are, do not show the practical application of these improvised barriers in situ.

Another good general resource on oral sex and HIV prevention is thebody.com.

Dams around the world: Lecktücher, digues dentaires, fazzoletti di lattice

In German the thick latex sheet used by dentists is called der Kofferdamm. For sex dams the Germans employ the more sexually suggestive word das Lecktuch (lick sheet), which for no apparent reason is in the neuter gender. The plural form is Lecktücher. One occasionally finds the more sedate term Latextuch, but it’s not as popular.

The French language is content to settle for a single term for the dental/sex dam. It is the (appropriately) feminine la digue dentaire. Digue is also the French word for dike.

The Italians use the term il fazzoletto di lattice (literally, latex hanky), whereas the Russians simply transliterate the technical German term: коффердам.

Be wary of Wikipedia entries

Wikipedia’s article on dental dams is adequate for a simple explanation of their use by dentists. But it is very disappointing for the sex researcher, devoting all of two sentences to the subject of their sexual use. You will have to go to the entry on cunnilingus to get more on the safer sex angle. As we have seen, there are far better sources on the web for this kind of information.

The German Wikipedia has a lengthier article, whose only reference, curiously, is to the Canadian site sexualityandU’s page on dams.

The French Wikipedia entry falls somewhere between the English and the German coverage. Its single reference is to a poorly illustrated, bare-bones instruction page on a French AIDS prevention website. Come on, francophone colleagues. Get snapping.

The Italian Wikipedia entry provides only very general information, like the French. But the Italian entry at least has a reference to a relatively decent PDF on lesbian health issues.

The Russian Wikipedia entry is all business, i.e., dentistry only. The sexual use of коффердам (a transliteration of the German term) is as far from view as Lenin in his tomb.

Plastic wrap around the world

It’s a relief to see that, despite the lack of adequate research support, there is general agreement in many countries that the clear, scritching, clingy stuff we use to keep old pizza slices in the fridge is not the best means of warding off a serious sexually transmitted infection.

In French the term for plastic wrap is film alimentaire. Browsing through various French websites I saw general consensus that le film alimentaire n’est pas du tout recommandé (because it’s porous).

The Italians concur: la plastica alimentare è un mezzo poco sicuro (plastic wrap is a less secure method).

German safer sex sites also consider die Haushaltsfolie (lit. “household foil”) as less than ideal, to be used nur im Notfall (only in a pinch).

Saran wrap is a wonderful invention. It’s irresistible for pranksters and goofballs too. The Urban Dictionary defines it thus:

saran wrap: the original (1950s, early 1960’s ?) clear foodwrap that teens used when they were too scared to go buy condoms. “I’m a saran wrap baby.”

Beneath the humour, however, is the sticky reality that plastic wrap is commonly being used for purposes for which it was never designed. In light of the significant concern about the risks of using plastic wrap for any kind of sexual encounter, it is inexcusable that science has not given it the kind of attention that has been lavished on condoms, gloves, masks and other barriers to infection. It is not stretching a point to assert once again that more research is urgently needed.

A note on kissing and STIs
My contact in public health also expressed concern that I had linked kissing with transmission of the human papillomavirus. I believe there is adequate support in the literature for this position [1,2]. In short, along with things like the common cold, mononucleosis, influenza and meningitis, kissing can also pass on some sexually transmitted infections: HPV, herpes simplex, and syphilis.

References

1. Slots J. Oral viral infections of adults. Periodontology 2000. 2009 Feb;49(1):60-86.

2. Kreimer AR. Oral sexual behaviors and the prevalence of oral human papillomavirus infection. J Infect Dis. 2009 May 1;199(9):1253-4.

dental-dam-kit

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