The nurse practitioner bustles out of the back room, sweat staining the underarms and belly of her cloud-print scrubs. My appointment is over, and I’ve been sitting in Planned Parenthood Toronto’s waiting room for about ten minutes.
“Sorry,” she says genuinely, “These were all I could find.” She hands me four individually-wrapped dental dams, dust slicking the top one’s package. With that, I’ve cleaned out the house.
Surprised, I put out a very scientific call to my Facebook friends, asking whether they had ever used a dental dam. These are people who talk a lot about sexual consent and safety, and I was stymied to learn that not only had most of them never seen a dam, many actually had no idea what one was. My friend Jasmine, whose education is above-average when it comes to sex, texted to ask: “Am I too innocent to be your friend?” There were only a few people who said they had encountered a dam in real life, mostly sex workers and queer folks.
In case you’re one of the many who don’t know: a dental dam—not to be confused with the internal condom, which has a flexible ring and fits inside the vagina—is a rectangular strip of latex, sometimes flavoured, that is spread over the vulva or anus and used as a barrier to prevent the transmission of STIs during oral sex. (They’re also used by dentists to isolate teeth during dental procedures). Stroll down any pharmacy aisle in any city in Canada, however, and while you’ll see rows on rows of multi-coloured condoms—flavoured ones, latex ones, super-thin ones, ribbed ones, extra-large ones, latex alternatives (if you’re lucky)—you are highly unlikely ever to spot a dam.
This is an obvious problem because STI rates are on the rise and barrier methods are the only way to prevent the skin-to-skin contact that allows them to spread.
Dams are, admittedly, not the sexiest invention to ever hit the sheets. In the words of one of my friends, who is a gay man: “It’s like eating a yogurt with the lid still on.” But this is not the cause of their sparse distribution. It turns out there’s another reason dental dams are so hard to find: they haven’t been licensed for use as oral barriers for sexual purposes in Canada, meaning they can’t be marketed or sold that way.
In order for distributors to do so, the manufacturer needs to submit an application to Health Canada to prove that the device meets its regulations for safety and effectiveness. So far, no manufacturer has.
“Dental dams intended for dental purposes are Class I medical devices since they are intended to be used only by dentists to isolate a tooth that is being worked on,” explains Anna Maddison, a senior media relations advisor at Health Canada, in an email. “Dental dams intended for the prevention of sexually transmitted and blood-borne infections pose a higher risk to Canadians if they do not function as intended, and as such are Class III medical devices.”
So, it’s no wonder we never see them anywhere.
There’s currently no framework in place for getting dental dams approved for STI prevention
Pamco Distributing is a major health distribution company that sells rubber dams in Canada. While the dams appear to be the same product as an oral barrier, they must be sold—and labelled—as dental dams. The president of that company, Perry Maclean, says it’s unclear how it might go about testing the dams to qualify as a Class III medical device in Canada, but he says that lack of clarity didn’t stop him from trying. Pamco has worked with one of its manufacturers, U.S.-based Global Protection, to try to figure it out, but Maclean said the process is “unclear, onerous, and expensive.”
“We are reviewing what the options are in terms of making ‘oral barriers’ available in Canada and that ultimately means being approved by Health Canada,” he says. “This includes looking at what testing needs to take place, costs, and if it is actually possible to test this product to be designated Class III status.”
It makes sense that Maclean is confused: since no dam has ever been approved in Canada, there’s no specific testing protocol in place to his knowledge—although the organization notes it could be informed by that for latex condoms. (In the U.S., dams are legally regulated for sexual purposes and classified at the same level as condoms.)
Yes, you *can* get an STI through oral sex
When it comes to oral health, people underestimate the likelihood of contracting STIs, and so they sometimes think of dams as overkill. But many STIs—including chlamydia, gonorrhea, herpes, HPV and syphilis—can be contracted through giving or receiving oral sex. Not to fearmonger, but STI rates aren’t getting any lower, either: according to the most recent national data, chlamydia, which is the most commonly reported STI in Canada, rose from 39,372 reported cases to 116,460 reported cases annually between 1998 and 2015, while gonorrhea spiked from 5,076 reported cases to 19,822 reported cases during the same time period. Even syphilis rates rose a fair bit, from 501 reported cases to 4,596 reported cases, which is weird given that it was almost a nonentity two decades ago.
Anecdotally, Ali McGill, a nurse practitioner who has worked in several sexual health clinics in Saint John, N.B., says she’s seen a rise in transmission of herpes simplex virus type one—a.k.a. cold sores on the mouth—being transmitted to people’s genitals through oral sex.
“It’s possible to contract herpes without ever having had any kind of intercourse,” she cautions. “Dental dams are important. More people should use them. All kinds of sexually transmitted infections can be housed in the mouth, and they can be transferred to the vulva.” McGill says that dental dams are comparable to condoms in STI prevention effectiveness, meaning they are generally over 90 % effective when used properly.
While the current classification impedes the marketing and ultimately the distribution of dams for sexual purposes, the government acknowledges that people can tend to get… creative with their medical devices, and because dental dams are considered safe for use around the mouth, it seems likely that they’re also safe to use during oral sex.
The government goes a step further and, in literature on STIs published by the Public Health Agency of Canada outwardly recommends using dams to avoid STI transmission.
There’s also a DIY dam option
While McGill maintains that dams can be an important STI prevention tool, the Saint John clinics she’s worked in don’t stock them.
Instead, she suggests repurposing a condom to suit non-phallic body parts. McGill demonstrates for me one afternoon, slicing open a kelly green condom. First, she ducks out of the room so she can recruit a nearby nursing student to watch (“I wouldn’t think she’d see this very often,” she calls over her shoulder).
To transform the condom, all you have to do is slice off the ring at the bottom, then slice through the condom to make a latex rectangle.
And in case you don’t want to be reminded of a penis immediately before sex, it *is* possible to buy dams in Canada, even though they’re not approved for sexual purposes, on Amazon or at your local adult store. And anecdotally, I’ve also heard that Saran Wrap works in a pinch (and McGill says it’s better than nothing)—although wouldn’t it be great to have access to a legitimate, tested, Health Canada-approved option that *wasn’t* sold in the food storage aisle?