Safer Sex in an Open Relationship: What Studies Show About Protection and Health

When couples think about an open relationship, hotwifing or cuckolding, a very sober question comes up sooner or later: What about our health? In theory, more sexual partners mean more opportunities for sexually transmitted infections (STIs). For many people, that’s even the strongest argument for monogamy.

But what does the picture really look like? What does research know about how people in consensually open relationships protect themselves, compared with people who are officially monogamous? And what does that mean for you in practice? This article summarizes the research on safer sex in an open relationship and gives you an overview of sensible protective measures. It doesn’t replace medical advice, but it helps you ask the right questions.

Monogamy as a promise of protection

In a series of studies on the stigma surrounding consensual non-monogamy, Terri Conley and colleagues asked what advantages people see in monogamy. Alongside commitment, health was named most often, above all protection against sexually transmitted infections (Conley, Moors, Matsick and Ziegler, 2013).

That makes sense: if two people have sex exclusively with each other and both were tested beforehand, the risk really is low. The catch lies in one word: if. Monogamy only protects when it’s actually practiced. And this is exactly where the research comes in.

What studies show about protective behavior

Infidelity versus open agreements

In an anonymous online survey, Conley, Moors, Ziegler and Karathanasis (2012) compared two groups: people who secretly cheated in a relationship agreed to be monogamous, and people who practiced open, negotiated non-monogamy with their partner.

The result was clear: the secretly unfaithful participants reported significantly less protective behavior, both during sex with their main partner and in contacts outside the relationship. They were also less likely to get tested for STIs regularly and less likely to talk about safer sex with new partners.

In a follow-up analysis, Conley and colleagues examined how correctly condoms were used. Here, too, people in consensually open relationships did better than the secretly unfaithful (Conley, Moors, Ziegler, Matsick and Rubin, 2013).

Open relationships compared with monogamous ones

In another online study, Justin Lehmiller (2015) compared people in consensually non-monogamous relationships with people in monogamous relationships. Participants in open relationships reported more sexual partners on average. At the same time, they more often said they used condoms, both with their main partner and with other partners, and that they got tested for STIs more often.

What these findings mean, and what they don’t

The studies suggest that risk doesn’t depend on the number of partners alone, but strongly on how openly and consciously protection is handled. In that sense, secret infidelity is especially risky, because the partner being cheated on has no chance to protect themselves.

At the same time, a few important limitations apply:

• The studies are based on online surveys with self-selected participants. They are not representative of the general population.
• They rely on self-reports, not medically measured infection rates.
• The data come mostly from the USA.
• Even with better protective behavior, more partners don’t automatically mean the same risk as practiced, tested monogamy.

So the honest summary is: an open relationship isn’t automatically a health risk, but it isn’t risk-free either. It calls for conscious decisions.

Why openness protects

That consensually open couples did better in these studies is easy to explain psychologically. If you talk openly with your partner about other contacts, you can also talk openly about protection. Rules about condoms, testing and contraception become part of your shared agreement. Someone who cheats in secret, by contrast, has an interest in leaving as few traces as possible, and that includes questions, testing appointments and conversations about protection.

For cuckold and hotwife couples, this is a strength: you have the chance to plan your health together from the very start. Use it.

Safer sex in an open relationship: the key protective measures

The following points give you some orientation. Which measures make sense for you specifically is best discussed with a doctor, a gynecology or urology practice, or a sexual health clinic near you.

Condoms

Condoms are still one of the most important protective measures against many sexually transmitted infections. However, they don’t fully protect against all pathogens, for example those that can be transmitted through skin contact. What matters is the right size, correct use and a new condom for every contact. The study on condom use errors shows that this last point can’t be taken for granted.

Regular testing

Many STIs cause no symptoms or only mild ones. That’s why regular testing makes sense, for everyone involved, including the Bull. In many places, public health services or sexual health clinics offer anonymous and often free or low-cost counseling and testing for HIV and other sexually transmitted infections. Your family doctor, a gynecology or urology practice and specialized testing centers are other options. Which tests make sense and how often depends on your contacts, so get advice.

Vaccinations

Vaccines exist against some sexually transmitted pathogens, for example hepatitis B and certain types of human papillomavirus (HPV). Whether a vaccination is right for you, or whether a booster makes sense, is best clarified with your family doctor or a gynecology practice.

HIV PrEP

HIV pre-exposure prophylaxis (PrEP) is a medication that HIV-negative people can take preventively to protect themselves from HIV infection. Whether and how the cost is covered differs by country and health system. PrEP doesn’t protect against other STIs and therefore doesn’t replace condoms for comprehensive protection. Whether it makes sense for you belongs in a conversation with a doctor.

Contraception

Besides infections, an unplanned pregnancy is also a topic you should settle in advance. What contraception do you use? What happens if a condom fails? Emergency contraception (the “morning-after pill”) works more reliably the earlier it’s taken; how you can get it differs by country. Sort out questions like these calmly, not only when it’s urgent.

Adding health rules to your agreement

Health should be a fixed part of your shared rules. Possible points for your agreement:

• Condoms required for all contacts with third parties, with no exceptions and no negotiating “in the moment.”
• Recent test results as a prerequisite before any intimate contact.
• Your own tests at regular intervals, coordinated with medical advice.
• Duty to inform: If anyone notices symptoms or gets a positive test result, they tell everyone involved immediately.
• A plan for mishaps: What will you do if a condom breaks or slips off?
• No alcohol or drugs to a degree that affects decisions about protection.

Write these rules down together so that everyone remembers the same thing later.

The health talk with the Bull

Talking about testing and protection may feel unsexy at first. In truth, it’s a sign of respect, and an excellent test of the other person’s character. A few phrases that can help:

• “Health matters to us. When were you last tested?”
• “Our rule is: always with a condom. Is that okay with you?”
• “We get tested regularly and expect the same from our partners.”

Research by Conley and colleagues shows that people who cheat in secret are less likely to talk about safer sex with new partners. Conversely, a Bull who asks about testing on his own and treats condoms as a given is a good sign. Anyone who brushes it off, takes offense or applies pressure is not the right partner, no matter how well everything else fits. More tips are in our guide on how to find a Bull.

Health starts with an honest conversation

All the protective measures described here depend on one thing: that you talk openly with each other, about wishes, limits and uncomfortable topics too. If that very step is hard for you, The Swartz Method by Judith Swartz can help. The e-book shows you how to raise the subject with empathy and how to turn a fantasy into a shared project with clear agreements, including the health rules you’ll want to settle together.

Frequently asked questions

Are open relationships more dangerous than monogamous ones?

Not across the board. More partners raise the risk of infection in theory, but studies show that people in consensually open relationships use condoms more often and get tested more often than comparison groups (Conley et al., 2012; Lehmiller, 2015). What matters is handling protection consciously.

Is a condom enough protection?

Condoms protect against many, but not all, sexually transmitted infections. Regular testing, appropriate vaccinations and medical advice add to that protection.

Where can I get tested anonymously?

In many places, public health services and sexual health clinics offer anonymous, often free or low-cost counseling and testing. Community testing centers and counseling services, as well as family doctors, gynecologists and urologists, are other options. What’s available differs by country and region.

Does the Bull have to show a test result?

That’s your decision. Many couples make a recent test result a prerequisite. What matters is that this rule is set in advance and applies equally to everyone involved.

Sources

1. Conley, T. D., Moors, A. C., Ziegler, A. and Karathanasis, C. (2012). Unfaithful Individuals Are Less Likely to Practice Safer Sex Than Openly Nonmonogamous Individuals. The Journal of Sexual Medicine, 9(6), 1559–1565. https://doi.org/10.1111/j.1743-6109.2012.02712.x
2. Conley, T. D., Moors, A. C., Ziegler, A., Matsick, J. L. and Rubin, J. D. (2013). Condom Use Errors Among Sexually Unfaithful and Consensually Nonmonogamous Individuals. Sexual Health, 10(5), 463–464. https://doi.org/10.1071/SH12194
3. Conley, T. D., Moors, A. C., Matsick, J. L. and Ziegler, A. (2013). The Fewer the Merrier?: Assessing Stigma Surrounding Consensually Non-monogamous Romantic Relationships. Analyses of Social Issues and Public Policy, 13(1), 1–30. https://doi.org/10.1111/j.1530-2415.2012.01286.x
4. Lehmiller, J. J. (2015). A Comparison of Sexual Health History and Practices Among Monogamous and Consensually Nonmonogamous Sexual Partners. The Journal of Sexual Medicine, 12(10), 2022–2028. https://doi.org/10.1111/jsm.12987