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Sexually Transmitted Diseases

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Sexual health, Sexually transmitted diseases -- Prevention


Change is constant in sexual health, as in health care more broadly. Novel pathogens are identified, epidemics emerge and reemerge, and new preventive and therapeutic agents are introduced and taken up by populations. On the other hand, some care strategies and practices fall by the wayside among clinicians and populations. Just as health and health care evolve, so too should the language that we use to describe them.

In this commentary, we express our concerns about the use of ambiguous and stigmatizing language when describing sexual behavior. A search on PubMed in September 2019 yielded over four thousand articles with “unsafe sex,” “risky sex,” “risky sexual behavior,” “high-risk sexual behavior,” or “sexual risk behavior” in the title or abstract alone, including papers recently published in STD and other leading journals.1–10 We propose that the language we use to describe sexual behavior should be updated to reflect the current landscape of sexual health and sexually transmitted infections (STIs). In 2014, at the request of HIV advocates, the Centers for Disease Control and Prevention agreed to discontinue the use of the phrase “unprotected sex,” opting for the more precise “condomless sex.”11 However, the continued use of ambiguous and stigmatizing language in the scientific literature points to the need for further action. We recommend that STD and other peer-reviewed journals, especially those that frequently publish content about sexual behavior, adopt an explicit policy to promote authors’ use of precise and neutral language when referring to sexual behaviors and potentially associated risks. We provide alternative language to support authors and journals in achieving these aims.


This is the author's accepted manuscript of an article that subsequently appeared as Marcus, J. L., & Snowden, J. M. (2020). Words Matter: Putting an End to “Unsafe” and “Risky” Sex. Sexually transmitted diseases, 47(1), 1.. The version of record may be found at 10.1097/OLQ.0000000000001065



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