It may seem like an easier option, less intimate, and with no risks, especially among the young generation, but beneath the surface lies a hidden pile of risks that many overlook.
Oral sex has become more commonplace, as young people experiment with dating and sex, while avoiding pregnancy and protecting themselves against HIV/Aids and other sexually transmitted illnesses (STIs).
Doctors say the popularity of oral sex is worrisome because many Kenyans believe it is so safe that they need not take precautions against sexually transmitted diseases.
It may not carry the same immediate risks as unprotected intercourse but it comes with its fair set of health concerns.
Dr Vic Albert, a urologist, says oral sex is not as harmless as people assume.
“People tend to exchange so many partners and don’t see the harm in oral sex. But in reality, it has its risks,” he says.
One of the major concerns associated with oral sex is the risk of STIs. Dr Albert explains that infections like syphilis, herpes, gonorrhoea, and chlamydia can all be transmitted through the mouth, tongue, and saliva. But the most concerning of all, he says, is the Human Papillomavirus (HPV), which is linked to various cancers.
“The most important infection we see is HPV, which is associated with cancer. We have seen in the recent past that men are developing throat cancer, or what we call oropharyngeal carcinoma, because of oral sex,” he says.
"And syphilis is back, affecting teenagers and students more," says Dr Gacheri Kathiri, a clinical dermatologist and aesthetic practitioner. "Even today, I have just seen patients, young boys and girls."
He says HPV does not always lead to cancer immediately. Persistent infections are what cause cervical cancer in women and throat cancer in both men and women.
“Cervical cancer has been a common problem in women for a long time. But men are also now suffering from throat cancer, which is mostly associated with HPV. If a man has oral sex with a woman who has HPV, he is likely to end up with an oral infection, and if that infection persists, it could lead to cancer,” the doctor says.
According to the expert, the cycle of transmission is concerning. If a man contracts oral HPV, he can pass it back to a woman through further genital sexual contact which increases her risk of developing cervical cancer.
The concern is that oral sex is also common among adolescents who know little about the risks. In a study done in the US, about 26 percent of high school students had had oral sex, and 4 percent had engaged in anal sex.
The researchers noted that there has been a significant rise in the prevalence of oral sex and a decline in the age at which it starts - with little awareness of the health risks. Kenya has no local data, however as Western culture impacts African traditional society, more teens are likely to pick the trend.
According to the Kenya Demographic and Health Survey (KDHS), a significant portion of the population experiences their first sexual encounter before the age of 15. In this age, most may not know the dangers of oral sex.
Oral HPV often has no noticeable symptoms, meaning that most people with oral HPV infection are unaware they have it.
However, in some cases, it may manifest as small, white, or red lesions, sores, or warts on the tongue, tonsils, soft palate, or inside the cheeks. It may also be accompanied by a persistent sore throat, hoarseness, or difficulty swallowing, which is an indication of progression to throat cancer if left untreated.
Apart from the physical health risks, oral sex has a psychological effect on some individuals. Dr Albert has encountered patients who develop extreme anxiety or obsessive behaviours after engaging in the ordeal.
“Some people come to the clinic thinking they have bad breath or constantly washing their mouths, only for us to discover that their distress comes from engaging in oral sex when they didn’t want to,” he says.
It also happens in relationships where one partner dominates the other. Some partners will engage in acts that they are not comfortable with which can lead to emotional distress.
“Not everyone wants to have oral sex, but they give in to pressure from their partners. This can affect them psychologically, even if they don’t realise it immediately,” he adds.
"With the trends we are seeing, we would say it’s unsafe because you may not be able to screen your partners all the time. If possible, you want to avoid oral sex,” he advises.
However, the doctor, says for those who still choose to engage in it, there is a protection method that exists although it is not commonly known, and neither is it widely used.
“People know about condoms for penetrative sex, but very few know about dental dams, which are like condoms for oral sex. These can help reduce the risk of infection, but they are not widely publicised in our setup,” Dr Albert says.
On the flip side, many people underestimate the long-term effects of STIs acquired through the tongue and saliva. The expert says some infections may seem mild initially but can cause severe complications later in life.
“We have seen women struggling to get pregnant because they ignored a sexual infection they got years ago. Some infections don’t just end with symptoms they lead to serious complications like infertility,” he says.
“For instance, every sexually active woman is supposed to go for a Pap smear annually to detect HPV and precancerous cells early. However many don’t follow this advice, which increases their risk of developing cervical cancer later on.
The problem is that people don’t realise the consequences until it’s too late. Most fear HIV, but they forget about HPV, Gonorrhoea, and other infections, some of which have worse complications than HIV,” Dr Albert adds.
Dr Kireki Omanwa says that chlamydia, in particular, is a silent but dangerous infection.
“Chlamydia is one of the biggest enemies because it has no symptoms at all. Many women struggling with infertility have blocked tubes, and from my experience, chlamydia is often a contributing factor,” he says.
Being a silent disease with no symptoms, if a woman has genital chlamydia infection, it can be transmitted to a man’s throat.
When it comes to HPV, the expert says that a woman’s immune system can get rid of most HPV infections, however, some aggressive strains especially types 16 and 18 can lead to cervical cancer.
“If HPV is transmitted through oral sex, it can affect the breathing mechanism. It can block the windpipe which will lead to serious challenges later on, and in some extreme cases, it can cause death due to the airway obstruction.”
About 5,400 Kenyan women are diagnosed with cervical cancer every year.
“And out of that, we lose about 3,600 women, which is very unfortunate. But cervical cancer is a disease which has been eliminated in some other countries,” he adds.
Unfortunately, there will be no symptoms until it is very late and when the symptoms come, it can be, for example, having vaginal bleeding after intercourse.
“Even though this can also be attributed to some other diseases, it is advised that women need to have a check,” Dr Kireki says
HPV also causes genital warts and when a patient has genital warts and is expectant, it can pass to the baby.
“She must give birth through Caesarean section because if she were to deliver the normal way the baby can get infected,” he adds.
The key, Dr Kireki, says lies in awareness, testing, and responsible sexual practices.
“Have regular check-ups, every two to three years. In the Western world, it has been eliminated easily because of regular check-ups. Also, women should prioritise getting an HPV test, it is more accurate than a pap smear and only needs to be done every five years,” he says.
In most instances, protection is rarely considered in oral sex, which makes the transmission even easier.
“Unless they want to have oral sex with a man using a condom, which I don’t think is something they consider, they are at high risk,” Dr Kireki says.
