The risk of Hep C transmission through sexual contact is generally low. However, it is possible to get the virus or pass it on to other people through sex if blood is present, such as menstrual blood when a woman is having her period or blood from tiny cuts or tears during rough sex. Examples of this include fisting or prolonged sex without lubrication. Blood can also be present:
- when people have cracks or cuts on their lips or in their mouth (that often occur with homemade or broken crack pipes), which means that even oral sex has the potential to spread Hep C
- on sex toys
- in lubricant taken from a shared container
The presence of HIV or other sexually transmitted infections (STIs) can also increase transmission of Hep C, especially among HIV-positive gay men, bisexual men and other men who have sex with men (MSM). (For more information, see CATIE's Prevention in Focus article, "Sexual transmission of hepatitis C: Are HIV-positive gay and bisexual men at risk?")
Under these circumstances, using a condom, glove or dental dam will reduce the risk of hepatitis C transmission by reducing exposure to blood.
Of course, safer sex is not just about condoms.
Some research says that the lifetime risk of Hep C transmission via unprotected sex in a lifelong monogamous heterosexual relationship is less than 5%. For some people, that risk is low enough to never use a condom. However, unprotected sex can also expose people to other infections, such as HIV, other STIs or hepatitis B. Getting co-infected with a combination of diseases can have more serious impacts on a person’s health than one disease alone.
Of course, safer sex is not just about condoms. The choice to have safer sex requires willing partners, personal commitment and access to supplies like lube, dental dams, latex gloves and condoms. Learning to negotiate with a partner involves communication and trust and can be undermined by the pressure of instant sexual gratification or the need to feel intimate or included. Fear of rejection or low self-esteem can lead people to choose pleasure over protection, even though the two are not mutually exclusive.
Safer-sex options—including access to external (male) and internal (female) condoms—learning how hepatitis C can be transmitted sexually and how to make safer-sex decisions and, ultimately, the autonomy to make such decisions will empower people to make informed choices that are right for them.