Whether or not you’ve had lower surgery, the basic information about safer sex is pretty much the same: use a barrier such as a condom or a Femidom along with water-based lube. Lube is especially important as, depending on the type of surgery you've had, your vagina may not naturally lubricate, so lube will help to prevent tearing and will make sex more comfortable.
Some sexually transmitted infections (STIs) such as genital warts and herpes are passed on through close skin contact, so a condom won’t necessarily protect you against these infections.
Is my risk of STIs different depending on the type of surgery I had?
If your vagina was made using skin from your colon (known as an intestinal implant or colovaginoplasty) it may be easier to get some STIs. This is because intestinal skin is a mucus membrane and some STIs can easily penetrate it.
A vagina created from penile and testicular skin is less vulnerable to STIs as it isn’t made from a mucus membrane. However, if the skin tears this could be a way for STIs and HIV to enter your body. If you have any warts on your penis have them treated before surgery, otherwise they can continue to grow inside your vagina.
Vaginal or anal sex
If your partner penetrates your vagina or anus during sex, they should use a condom or you can use a Femidom, if appropriate, to protect you both from STIs and HIV. Vaginal sex may be uncomfortable and cause bleeding (a way for STIs and HIV to get into or out of the body) especially if you've recently had surgery.
Using dilators to stretch the vaginal skin will help, as will using plenty of water-based lube during sex. Dilators may sometimes cause bleeding, so if you have sex after using one make sure you use a condom or Femidom.
If you have had lower surgery, remember that your anus - as well as your vagina - might be delicate afterwards while your genital area recovers. A lot of nerve endings in the genital area are close together so it's possible that anal sex will hurt if your body hasn’t recovered properly from surgery.
Although everyone has a different healing process, it can be around two to three months after surgery before you'll feel like having sex. Note that some doctors recommend waiting two to three months before having penetrative vaginal sex to allow the area to heal.
If your partner is a trans man, he may not be able to use regular-sized condoms but he can seek advice about other appropriate barriers. Our booklet Trans Health Matters: Sexual Health, HIV and Wellbeing for Trans Women has further information.
Oral sex is a lower risk sexual activity than anal or vaginal sex but it's still possible to get or pass on STIs or HIV this way. There have been a few cases of people acquiring HIV from oral sex.
If someone gives you oral sex when you have recently had lower surgery, any unhealed wounds could provide a way for STIs to get into your body or theirs.
Ideally use a condom or dental dam if you're giving someone oral sex. If you don’t, ask your partner not to come in your mouth.
If you share sex toys with someone, put a condom over the sex toy every time a new person uses it or if it's moved between your vagina and anus, as this can transfer bacteria.
If you have multiple partners during one sex session or if you like rougher sex:
- Use a different condom with each partner.
- If you enjoy bondage, fisting or S&M be aware that any bleeding or tearing of the anus, vagina or mouth can provide routes for STIs, HIV and hepatitis into your body or your partner’s.
- If you're fisting, use latex gloves and don’t share a pot of lube as minute traces of blood can be transferred onto your hands making it easy to pass on hepatitis C.