FDA authorizes a type of underwear to protect against infection during oral sex

This is a story about infections, sex and underwear. More specifically, it is about sexually-transmitted infections, oral sex and ultrathin, super-stretchy, vanilla-flavored panties.

The Food and Drug Administration has authorized the panties to be considered protection against infections that can be transmitted from the vagina or anus during oral sex. It is a first for underwear.

The undies are part of an understudied but important area of ​​sexual health where the few options for protection are considered cumbersome and hardly used.

“Oral sex is not totally risk-free,” said Dr. Jeanne Marrazzo, director of the division of infectious diseases at the University of Alabama at Birmingham. She said the need for protective methods was of growing importance because more “teenagers are initiating their first sexual activity with oral sex.” For people of all ages, she added, a protective barrier that is enjoyable to use could “reduce anxiety and increase pleasure around that particular behavior.”

Infections like herpes, gonorrhea and syphilis can be transmitted through oral sex, according to the Centers for Disease Control and Prevention. The risk of transmitting HIV from a vagina through oral sex is considered very low, the CDC said. But HPV — human papillomavirus — is more easily transmitted that way, and mouth and throat infections from some types of HPV may develop into oral or neck cancer, the agency said.

How often people transmit infections in this manner is unclear and difficult to study because most people who have oral sex have vaginal or anal sex in the same encounter, said Dr. Kenneth Mayer, the medical research director for Fenway Health, a community health center in Massachusetts that focuses on patients who identify as LGBTQ.

“The FDA’s authorization of this product gives people another option to protect against STIs during oral sex,” said Courtney Lias, director of the FDA office that led the review of the underwear.

The only product previously authorized for protection during oral sex was a dental dam — a thin, rectangular sheet of latex (or sometimes polyurethane) that typically must be held in place with one’s hands to form a barrier between the mouth and genitals.

As the name suggests, dental dams, invented in 1864 and originally made of rubber, were designed to isolate teeth during dental procedures. But the AIDS crisis ignited concern about sexual transmission of infections, and in the early 1990s an Australian company, Glyde Health, created a dental dam that was primarily inspired by concerns of women who have sex with women, an official with the company has said.

Although several brands of dental dams have received FDA clearance for protection against sexual disease transmission, the devices have not exactly been a hit.

“They’re extremely unpopular,” Marrazzo said. “I mean, honestly, could there be anything less sexy than a dental dam?”

There is little data on how widely they are used, but a 2010 study of 330 Australian women who had sex with women found that only 9.7% reported ever using a dental dam, and just 2.1% said they used dams often. A 2021 CDC report said use of dental dams and other safe-sex methods was “infrequent” among women who have sex with women.

Dams are sold online and in sex shops but are not widely available at pharmacy chains and are usually more expensive than condoms. The CDC’s webpage on dental dams shows how to cut a condom to make a dental dam, but this does not appear to be popular either.

“Many people report that dental dams are awkward and take all the pleasure out of oral sex for both the giver and receiver,” said Chris Barcelos, an assistant professor of women’s, gender and sexuality studies at the University of Massachusetts Boston. “They are hated even more than condoms.”

The idea for damlike undies struck Melanie Cristol after an experience in 2014 during her honeymoon in Mexico with her then-wife. Cristol, then a corporate lawyer, discovered she had an infection that could be sexually transmitted.

Realizing how limited the protection options were, “I was just so discouraged,” said Cristol, who recalled that when she was a sex educator in college and taught about dental dams, “people looked at me like I was crazy.”

“I wanted to feel sexy and confident and use something that was made with my body and actual sex in mind,” she said.

Cristol formed a company that in 2018 began selling single-use underwear for “people with vulvas.” She said she named the product Lorals partly because the L sound “evokes words like love and lust, and it feels a little bit like a movement that you use” during oral sex.