Vaginal Sex and HIV Risk

Fast Facts

Both male and female partners can get HIV from vaginal sex.
Condoms, pre-exposure prophylaxis (PrEP), and antiretroviral therapy (ART) can reduce your risk of getting or transmitting HIV through vaginal sex. Even more protection is provided when more than one option is used.
Vaginal sex may also expose individuals to other sexually transmitted diseases.

Vaginal sex (intercourse) involves inserting the penis into the vagina. HIV can be transmitted during this activity if either partner is living with HIV. You can lower your risk for getting and transmitting HIV by using condoms correctly and consistently; taking daily medicine to prevent HIV, called pre-exposure prophylaxis (PrEP); and taking medicines to treat HIV if living with HIV, called antiretroviral therapy (ART). Using more than one of these options at the same time provides even greater protection.

Risk of HIV

Some sexual activities are riskier than others for getting or transmitting HIV. For an HIV-negative person, the riskiest activity for getting HIV is being the receptive partner (“bottom”) in anal sex. Being the insertive partner (“top”) in anal sex or having vaginal sex (insertive or receptive) is less risky, though either partner can get HIV through those activities as well. Activities like oral sex, touching, and kissing carry little to no risk for getting or transmitting HIV.

A woman can get HIV during vaginal sex because the lining of the vagina and cervix may allow HIV to enter her body if her male partner’s body fluids carry HIV, including blood, semen (cum), and pre-seminal fluid (pre-cum). Using condoms or medicines to protect against transmission can decrease this risk.
Men can also get HIV from having vaginal sex with a woman who’s HIV-positive because vaginal fluid and blood can carry HIV. Men can get HIV through the opening at the tip of the penis (or urethra); the foreskin if they’re not circumcised; or small cuts, scratches, or open sores anywhere on the penis. Using condoms or medicines to protect against transmission can decrease this risk.

Risk of Other Infections

In addition to HIV, a person can get other sexually transmitted diseases (STDs) like chlamydia and gonorrhea from vaginal sex if condoms are not used correctly. Even if a condom is used, some STDs can still be transmitted through skin-to-skin contact (like syphilis or herpes). Hepatitis A and B can also be transmitted through vaginal sex. Getting tested and treated for STDs reduces a person’s chances of getting or transmitting HIV through vaginal sex. If one has never had hepatitis A or B, there are vaccines to prevent them. A health care provider can make recommendations about vaccines.

Reducing the Risk

Condoms and Lubrication

Latex or polyurethane male condoms are highly effective in preventing HIV and certain other STDs when used correctly from start to finish for each act of vaginal sex. People who report using condoms consistently reduced their risk of getting HIV through vaginal sex, on average, by 80%. Condoms are much less effective when not used consistently. It is also important that sufficient water- or silicone-based lubricant be used during vaginal sex to prevent condom breakage and tearing of tissue. Female nitrile condoms can also prevent HIV and some other STDs. Since condoms are not 100% effective, consider using other prevention methods to further reduce your risk.

PrEP

People who are HIV-negative and at very high risk for HIV can take daily medicine to prevent HIV. Pre-exposure prophylaxis (PrEP), if taken consistently, can reduce the risk of getting HIV from sex by more than 90%. PrEP is much less effective when it is not taken consistently. Since PrEP is not 100% effective at preventing HIV, consider using other prevention methods to further reduce your risk. Only condoms can help protect against other STDs.

PEP

Post-exposure prophylaxis (PEP) means taking antiretroviral medicines—medicines used to treat HIV—after being potentially exposed to HIV during sex to prevent becoming infected. PEP should be used only in emergency situations and must be started within 72 hours after a possible exposure to HIV, but the sooner the better. PEP must be taken once or twice daily for 28 days. When administered correctly, PEP is effective in preventing HIV, but not 100%. To obtain PEP, contact your health care provider, your local or state health department, or go to an emergency room.

ART

For those living with HIV, antiretroviral therapy (ART) can reduce the amount of virus in the blood and body fluids to very low levels, if taken the right way, every day. When taken consistently, ART can reduce the risk of HIV transmission to a negative partner by 96%. Since ART is not 100% effective at preventing HIV, consider using other prevention methods to further reduce your risk. Only condoms can help protect against some other STDs.