What are the risks of HIV infection from vaginal intercourse?

Vaginal intercourse between partners is one of the most common ways a person can contract HIV. Both women and men can be at risk when they have vaginal sex without a condom.

Both parties share many common risk factors. There are reasons why men may be at risk, and there are other reasons why women may be more susceptible to HIV.

This article discusses why vaginal intercourse carries HIV risks for both men and women. It explains why anatomical differences, cultural norms, and even how well HIV treatment works can affect this risk.

Gender and Gender Identity

This article refers to both men and women when discussing vaginal sex and HIV risk. These terms describe the sex assigned at birth. Vaginal sex is sex between a person with a penis and a person with a vagina. At VigorTip Health, we respect the many ways in which a person can hold and express a sense of gender identity.

risk of sexual activity

In the United States, approximately 5,300 women develop new infections each year as a result of vaginal intercourse. There were about 2,400 new infections among men who had sex with women, although the vast majority of the 34,800 new cases were among men who had sex with other men.

To be sure, HIV transmission rates have increased over the years. But the bulk of the overall decline in cases has occurred in men, while progress in women has remained stagnant.

Globally, heterosexuals are by far the most affected group. For example, in African countries, vaginal intercourse is the most likely route of HIV infection.

When discussing HIV risk, people often focus on which “type” of sex is more risky. They compare vaginal, anal and oral sex. Based purely on numbers, anal sex is considered the highest risk activity. The risk of HIV infection from anal sex is almost 18 times that of vaginal sex.

Statistics are not personal. It’s true that vaginal sex may carry an overall “lower” risk compared to anal sex. What the data can’t tell you is how the risk of HIV infection may be different for men and women who have vaginal sex.

Risk data doesn’t always explain what makes some people more vulnerable. It does not take into account how these factors lead to a much higher risk of HIV infection than others.

Women are about twice as likely to contract HIV as men when engaging in heterosexual behavior. Women are more likely to contract HIV during their first sexual contact with men than their male partners.

Some men are more susceptible to HIV infection than others. Studies have shown that uncircumcised men are more than twice as likely to contract HIV after vaginal intercourse as circumcised men.


Vaginal intercourse is not the highest risk of HIV infection. However, it still poses risks to both parties, with women at greater risk than men. This is due to several factors, including vulnerability that puts women (and some men) at greater risk than others.

HIV/AIDS symptoms women should be aware of

Risk factors for women

Women who have vaginal sex without a condom are at higher risk for HIV for a number of reasons. Chief among them is the way the female body differs from the male body.

Normally, the body’s immune system recognizes and responds to an invading virus. Instead, HIV reverses its mission. Instead, CD4 T cells designed to help eliminate the threat are attacked. This means that the body supports its own infection instead of fighting it.

This epithelium The tissue lining the vagina is more susceptible to HIV infection than penile tissue. HIV can pass through these tissues.

The surface area of ​​these vaginal tissues is much larger than that of the urethra, the thin tube that runs through the penis and connects to the bladder. Therefore, women have a much higher chance of contracting HIV.

Other vulnerabilities based on gender differences include:

  • The cells of a woman’s cervix, located at the opening of the uterus, are particularly susceptible to HIV infection. This is especially true during adolescence or first pregnancy.Also if you have a sexually transmitted infection (STI) Chlamydia or human papillomavirus (HPV).
  • Women with reproductive tract infections (whether bacterial, viral, or fungal) are at increased risk of HIV infection. Some studies suggest that bacterial vaginosis is associated with an eight-fold increased risk. This is 1 in 100 cases of HIV infection during vaginal intercourse.
  • Sex without a condom increases a woman’s risk of HIV infection if the man ejaculates into the vagina. Key factors that affect risk include how long you’ve been exposed and how much infected fluid you have.
  • open sores or ulcers caused by sexually transmitted infections, such as syphilis Increased risk in both men and women. However, in women, the ulcers are not as noticeable as on the penis of men. They may be ignored.
  • Douching practice may alter the “good” flora of the vagina, although this is still debated.

Daily use of a type of HIV medicine called pre-exposure prophylaxis (PrEP) can reduce the risk of HIV infection in an uninfected partner. However, there is evidence that it is less effective in women.

Research models from a 2016 study of 49 women showed that levels of the active drug molecule were not as high in vaginal tissue as they were in rectal tissue for men who have sex with men.

Social vulnerability may also put women at greater risk. They include sexual violence in relationships. In these cases, women are limited in their ability to protect themselves and have a higher chance of causing damage to the delicate vaginal tissue.

Poverty, social norms and gender imbalances can all contribute to the privilege of men in relationships. Men’s dominance in other areas may also extend to the bedroom. All of these factors may contribute to higher rates of HIV infection in women.


Most of the reasons why women are at higher risk for HIV infection are anatomical. Vaginal tissue is more susceptible to infection than male penile tissue. Women are the recipients of fluids that are more likely to cause infection. Social factors may also put women at greater risk than their male partners.

risk factors for men

The fact that men are less susceptible to HIV infection than women should not underestimate the fact that, as individuals, they may still be at a higher risk of HIV infection.

For example, an uncircumcised penis still has an intact foreskin. This makes it easier for bacteria to get trapped under it and cause an infection.In response, the body produces what is called Langerhans cell Helps control bacteria.

When a man has condom-free sex with an HIV-positive woman, Langerhans cells transport the virus to CD4 T cells to destroy it. But with HIV, this may actually increase the chance of getting HIV. Sexually transmitted and reproductive tract infections further increase the risk of HIV infection.

In many societies, cultural norms of what it means to be a man encourage sex. Sexual adventure is seen as an expression of masculinity. As a result, men may have more sexual partners than women and engage in behaviors that increase HIV risk.

shared vulnerability

Men and women share some of the same vulnerabilities when it comes to HIV infection.

For example, alcohol or drug use affects both men’s and women’s ability to make safe choices. This can lead to sex without condoms, or change a person’s ability to stick to HIV medication.

If an infected partner of either sex has an increased amount of HIV in the blood (viral load), this increases the risk of an HIV-free partner. High viral loads during acute infection (immediately following exposure) are associated with an increased risk of HIV transmission.

On the other hand, a person with an undetectable viral load cannot transmit HIV to a partner through sex.


Uncircumcised men have a higher risk of contracting HIV through vaginal intercourse. Men may also engage in more risky behaviors. Alcohol and drug use may increase risk in both men and women. These choices may also affect the viral load of HIV-positive partners receiving treatment and increase the risk of transmission.

per exposure risk

One way to measure HIV risk is based on what is known as “risk per exposure”. This risk can vary by gender, the viral load of your HIV-positive partner, and even where you live.

For example, a woman who has vaginal sex with a man has a risk per exposure of 8 out of 10,000 such sex acts. The risk for men is 4 in 10,000. This may seem low, but these statistics do not reflect the reality that unprotected vaginal intercourse, even once, can lead to HIV infection.

Keep in mind that the per-exposure risk figures do not take into account any other factors that may increase risk. These factors include:

  • presence of sexually transmitted infections
  • injecting drug use
  • underlying infection, such as hepatitis C

accidental exposure risk

If you think you may have been exposed to HIV, a drug called post-exposure prophylaxis (PEP) can greatly reduce your risk of infection. PEP consists of a 28-day course of antiretroviral drugs that must be taken completely uninterrupted.

PEP must start as soon as possibleIdeally within 36 hours of exposureto minimize the risk of infection.

Types of antiretroviral drugs and how they work


Vaginal intercourse between a person with a penis and a person with a vagina carries a risk of HIV infection. Women are at higher risk than men for a number of reasons.

Much of the difference in HIV risk is due to differences in male and female bodies. The vagina is more susceptible to infection than the penis. It also accepts fluids that may be HIV-infected during vaginal intercourse. Social and cultural factors may also play a role.

Uncircumcised men also have a higher risk of contracting HIV through vaginal intercourse. For example, both sexes were at greater risk when alcohol and drug use changed their decisions about safe sex or ongoing HIV treatment.

VigorTip words

A healthy sex life is possible when both parties take the proper precautions. Even with HIV. Proper use of condoms and, in some cases, HIV treatment drugs can prevent transmission during vaginal sex. Be sure to discuss any concerns with your healthcare provider.

Frequently Asked Questions

  • What is the risk of HIV from behavior other than sex?

    The highest risk of HIV transmission came from blood transfusions, with 9,250 cases per 10,000 surgeries. This compares to 63 per 10,000 people sharing needles while taking drugs, and 23 per 10,000 accidental needle sticks.

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  • Which age group has the highest risk of HIV infection?

    In 2019, people aged 25 to 29 had the highest number of new HIV infections. HIV diagnoses increased among 13- to 24-year-olds, 35- to 44-year-olds, and 45- to 54-year-olds. At any age, good information can help you cope with a new diagnosis.

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