Sarah Merson charts a way through the hazards lying in wait for allergic people trying to practise safe sex.

With the risk of unwanted pregnancies and sexually transmitted diseases, we’ve become accustomed to practising safe sex. This involves the use of contraceptive methods, including condoms, spermicides, diaphragms and intrauterine devices (IUDs). But, while taking steps to protect themselves from one danger, those with allergic tendencies may be exposing themselves to others.

However, while some people may suffer symptoms of allergy or intolerance to safe sex, ‘it is worth emphasising that true allergy to sex, rather than various contraceptives is rare’, says Dr Sophie Farooque, allergy specialist at University College London. ‘I have only seen one case of semen allergy over the last five years whereas I have seen 20 or so cases of latex allergy and four cases of exercise-induced anaphylaxis.’

Condoms & Diaphragms

Latex
Most common allergy is to latex which causes a very real problem for a lot of people when it comes to safe sex. To accomodate those with latex allergy condoms are now being made with natural rubber, polyurethane, or thermoplastic elastomer. We’re not just talking condoms but diaphragms and contraceptive sponges which may also contain latex.(For more information see Foods Matter section on latex allergy.)

Rubber
Condoms or cervical caps made from rubber are made elastic by a process called vulcanisation, and many of the chemicals used in the process are strong sensitisers or allergens. These chemicals may include isopropyl n-phenylenediamine, mercaptobenzothiazole and carba compounds. Affected individuals may suffer from contact dermatitis.

Silicone
Condoms, as well as diaphragms, caps and shields may be made from silicone rubber and many lubricants contain silicone. Silicone allergy is relatively rare but it may cause symptoms such as rashes and inflammation.

Casein
Casein is a protein found in milk and its adhesive properties are used in both edible and non-edible products as binding agents. Cow’s milk casein is sometimes used in latex condoms to improve their physical properties. This of course could cause those who are highly allergic to milk or milk products to react.

Additives (scents, flavourings and colourings)
Additives are often present in the lubricants used on condoms. These may include everything from desensitisers to delay ejaculation (lidocaine or benzocaine) to stimulants (such as papaverine to enhance erections) or artificial scents, flavourings or colourings for general pleasure. Many of these additives may cause allergic reactions, varying from irritated mucous membranes (itching, redness or discharge) to sores, inflammation, and increased susceptibility to urinary and fungal infections.

Dry dusting powders
Dry dusting powders are applied to latex condoms before packaging to prevent the condom from sticking to itself when rolled up. Previously, talc was used by most manufacturers (which can cause adhesions in the gut if it enters the abdominal cavity). Cornstarch is now a popular dusting powder, which may cause problems to those with corn sensitivity.

For a range of non-allergenic condoms, go to www.condomerie.com

Spermicides

Available in jelly, foam, cream and suppository forms, many spermicides contain an active ingredient called nonoxynol-9. Although nonoxynol-9 is an approved ingredient in spermicides, it may cause irritation or contact dermatitis on the skin of the penis or vagina. Depending on the amount used, it may cause sores and/or stripping of the vaginal and rectal lining, thereby facilitating an infection. As a result, in certain cases, spermicides containing nonoxynol-9 could even increase the risk of STD.

Intrauterine Device (IUD)

IUDs made of copper have been linked to everything from immunologic contact urticaria (ICU) to allergic contact dermatitis (ACD), systemic allergic reactions (SAR) and contact stomatitis (STO), for women who are sensitive or allergic to the metal. Most reports of immune reactions to copper describe systemic exposure as a cause. In the case of IUD use, systemic exposure may be implicated as small amounts of copper sulphate are absorbed through the mucus membrane and carried to the cutis through the blood or lymph.

For those who react to copper, the levonorgestrel (LNg) IUD, also known as Mirena, is a hormone-releasing IUD. It prevents fertilisation by damaging or killing sperm and making the mucus in the cervix thick and sticky, so sperm can't get through to the uterus. Ask your GP for details.

Human Seminal Plasma Allergy (HSPA)/Seminal Fluid Hypersensitivity

Allergy to semen is exceptionally rare, although seminal fluid hypersensitivity may be more common. Both conditions are usually caused by sensitisation to proteins present in the seminal fluid, leading to immediate hypersensitivity manifestations during or soon after sex.

Local symptoms of HSPA include vulvar and vaginal itching, burning, pain, redness, swelling and blister formation, whilst on the other end of the spectrum, HSPA can, in very rare cases result in life-threatening anaphylaxis. The most significant risk for anaphylaxis is in those with a history of allergic asthma or atopic dermatitis.

Once identified, HSPA may be prevented by the barrier use of condoms or can be treated with immunotherapy or by intravaginal desensitisation using a partner's seminal fluid, although the duration of protection is unknown.

Exercise-induced anaphylaxis

For some, exercise-induced anaphylaxis can cause problems during or after sex.

Exercise-induced anaphylaxis is a form of physical allergy. Symptoms can include diffuse warmth, itching and erythema where urticaria generally ensues and may progress to include gastrointestinal symptoms or vascular collapse. Factors that have been associated with exercise-induced anaphylaxis include medication (eg, aspirin and other nonsteroidal anti-inflammatory drugs) or food ingestion before and after exercise. Those suffering from exercise-induced anaphylaxis should carry epinephrine and might also have allergen immunotherapy vaccinations. Anyone under threat of anaphylaxis should wear and/or carry Medic alert identification denoting their condition.

Kissing – beware!!

A kiss is not just a kiss….at least not for those with a peanut allergy. Indeed, those suffering from a peanut allergy may put themselves at risk of potentially life-threatening allergic reactions if they kiss someone who has recently eaten peanuts. The best advice to the partner of a peanut-allergic person is that they too should avoid peanuts.

Courtesy of the Cavalier Daily
John Scott directed our attention towards this report by Anne Mills in the Cavalier Daily (the daily newspaper of the University of Virginia) which made us realise that sex, like most things in life, is never simple for allergic people...

Although it has revolutionised safe sex, latex isn't without its flaws. Some people are allergic to it and some find its texture and odour off-putting. Enter the synthetic condom. Initially available in 1995, the Durex Avanti was the first of these, with the eZ-on polyurethane and Tactylon condoms close at its heels.

The thrust, so to speak, of the marketing for these products is that they allow improved sensitivity without compromising strength. In addition to being odorless, colorless and non-allergenic, synthetic condoms also boast increased ‘heat transmissibility’ and longer shelf life compared to latex.

One area in which synthetic condom manufacturers cannot claim superiority, however, is in protection against pregnancy and STIs. Based on pore size alone, they theoretically should work as well as latex condoms, but in practice other factors also contribute to effectiveness. Subsequent studies have found higher rates of breakage in all synthetic condoms compared to latex. Based on this data, the general consensus is that while synthetic condoms are an acceptable alternative for those with latex allergies, latex remains the best option for everyone else.

First published in 2007

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