Experiences with Cling Film and Dental Dam Use in Oral SexA Mixed-Methods Systematic Review

Picture someone standing in a pharmacy, scanning the shelves before a date. Condoms — every size and every brand — practically wallpapered across the display. But they're looking for something else. Something for oral sex. They scan left, right, up, and down. Nothing. Most people wouldn't even know what to look for. That gap — between what exists, what's recommended, and what people can actually find and use — is exactly what a major systematic review by Kanmodi and colleagues set out to map. The question they asked is one that public health has largely sidestepped: when it comes to oral sex, what do people actually know, think, and do about protection? And what does that mean for policy? Oral sex is common. A multi-continental survey of twenty-six thousand and thirty-two adults found that roughly thirty-eight percent reported having practiced it. In the United States, about eighty-five percent of sexually active adults have engaged in oral sex. In the United Kingdom, the figure reaches eighty-six percent among adults. Even in countries where rates are lower — Nigeria, Kenya, and South Africa — the numbers are still substantial enough to matter for public health. Prevalence is highest among homosexual respondents, where over seventy-three percent reported oral sex experience, with males reporting giving oral sex at eighty-three percent versus females at seventy-seven percent, and receiving at eighty-one percent versus seventy-one percent. This is not a marginal behavior. It is a central part of sexual life for hundreds of millions of people. Yet oral sex carries real transmission risk. Kanmodi and colleagues document associations between oral sex and a wide range of sexually transmitted infections: HIV, herpes, syphilis, gonorrhea, chlamydia, hepatitis A, B, and E, human papillomavirus, and bacterial infections including shigellosis and typhoid fever. The authors note that "it can be projected that millions of people have sexually transmitted oral infections." The mechanism is straightforward — genital and anal fluids contacting oral mucosa — and the recommended countermeasure is a physical barrier. Three options appear in the literature: tongue condoms, dental dams, and cling film. Male condoms, documented at roughly eighty percent efficacy against HIV and other sexually transmitted infections during sex, are well established. The barrier tools specific to oral-vaginal and oral-anal contact are a different story entirely. A dental dam — also called a rubber dam — is a single-use latex square placed over the vaginal or anal opening to prevent direct mouth-to-mucosa contact during cunnilingus or anilingus. It works like a shield between the mouth and the receiving partner's genitals or anus. Cling film — plastic wrap, saran wrap, food wrap — is a thin transparent polythene sheet that some people use as an improvised substitute. It is thinner than a dental dam and more easily perforated by fingernails or teeth, which undermines its protective function. Neither of these is a new invention. Both have been recommended in sexual health guidance for decades. And yet, as the systematic review by Kanmodi and colleagues makes plain, almost nobody uses them. The review was conducted rigorously. The team searched eleven electronic databases on a single day in July 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses framework and registering their protocol on PROSPERO. They started with five hundred and twenty-nine records, removed duplicates, screened titles and abstracts, reviewed twenty-eight papers in full, and arrived at seventeen studies that met their quality criteria. Those studies together investigated five thousand five hundred and sixteen adolescents and adults across settings ranging from community samples to prisons to sexual health clinics. Most studies focused on women — twelve of the seventeen sampled women only. Most focused on dental dams. Cling film and heterosexual populations were barely represented. Quality appraisal used the Mixed Methods Appraisal Tool version 2018, and ten of the sixteen research articles scored the maximum seven out of seven. What they found from this carefully assembled body of evidence is striking. Knowledge of dental dams is generally poor. That is the review's headline finding on awareness, and it holds across nearly every study in the synthesis. Not poor in a vague way — poor in a documented, specific way. Muzny and colleagues reported that many women claimed familiarity with dental dams, but further questioning revealed confusion about what they are and how they are used, including conflating them with female condoms. Doull and colleagues recorded participants saying, "I didn't even know dental dams were even a thing." Emetu and colleagues noted that three participants had never heard of them. Kanmodi and colleagues characterize the overall picture as a "gross misconception or lack of knowledge of what a dental dam is." And for cling film? Not a single included study reported any measured knowledge of cling film as a protective barrier. Zero. Compare that to condoms. The review notes that condoms are "much more normalized and common," easy to obtain, available free at clinics, and widely displayed in stores. Dental dams, by contrast, are often absent from pharmacies, available mainly online or in adult shops, and in some settings — prisons, for instance — simply not stocked at all. Empty vending machines. Kanmodi and colleagues document inmates in prison settings stealing plastic wrap from kitchens to use as a makeshift substitute. That's the supply situation: one barrier product is everywhere, the other is functionally invisible for most people. The usage numbers confirm it. Across seven studies that measured ever-use of a dental dam during oral sex, the prevalence ranged from zero point six percent to twenty point one percent. The floor — zero point six percent — comes from Carlin and colleagues, looking at HIV-positive men practicing anilingus. The ceiling — twenty point one percent — was among women who have sex with women, the population most consistently targeted by dental dam promotion. Other large samples fill in the picture. Richters and colleagues found that eighty-six point seven percent of five hundred and forty-three women had never used a dental dam. Fujii reported ninety-two point four percent of one hundred and four participants had never used latex film in oral sex. Bailey and colleagues found eighty-six percent of two hundred and ninety-six participants who had had sex with women had never used one. Among female sex workers in Melbourne, Zappulla and colleagues found only three point one percent of those who had performed cunnilingus used dental dams consistently. In prisons, Yap and colleagues put the figure at four percent of female inmates who had ever used one. These are not the numbers of a tool that is working its way into mainstream practice. These are the numbers of a tool that has essentially not arrived. What keeps people from using dental dams is not simply that they don't know about them. The qualitative synthesis in the review adds texture to the picture. People who had tried dental dams described them as "too thick," "too dry," "powdery," "tasting like plastic," and reducing sexual sensation. They called them "awkward," "unsexy," "not user-friendly." Some said they "kill the whole thing" or "take all the fun away." Others said they couldn't imagine asking a partner to use one. There's a social dimension here too — the normalcy of condoms versus the strangeness of suggesting a dental dam. Many participants preferred relying on partner testing or perceived low risk over reaching for a barrier. That said, the review identifies some specific predictors of higher use. Gil-Llario and colleagues found that older age, high self-efficacy for dental dam use, assertiveness, non-use of cannabis during sex, perceiving HIV as serious, and perceiving personal vulnerability to HIV were each significantly associated with use, with p-values below zero point zero five. Richters and colleagues found that women who had engaged in oral sex involving blood were more likely to use dental dams — a perceived-risk trigger, with a confidence interval of one point five to five point nine and a p-value of zero point zero zero two. And in one prison survey, Yap and colleagues found that fifty-four percent of female inmates said they favored offering dental dams in that setting — a reminder that attitudes can shift when context and access change. The structural barrier is real as well. Dental dams can be compromised by oil-based lubricants, and their surface area is limited enough that fluid can seep around the edges. But here is the deepest gap in the evidence, and it matters enormously for policy: no study in the review reported any data on the health effects of dental dam or cling film use. None. There is no study measuring whether using a dental dam during cunnilingus or anilingus actually reduces sexually transmitted infection transmission. The tool is recommended. It is built. It is distributed — or should be. But whether it works at the population level, in the way that male condoms have been documented to work, has simply never been established through research. Kanmodi and colleagues flag this plainly: "Notably, no study was found to report the effects of cling film and dental dam use." That absence has to shape how we think about policy. Public health cannot keep telling people to use a tool without knowing whether it works, how well it works, or how to make it acceptable enough that people will actually use it. What should change? Kanmodi and colleagues are specific. First, experimental and observational research needs to be commissioned and funded to actually measure whether dental dams and cling film reduce oral sex transmission of sexually transmitted infections. That foundational question remains unanswered. Second, supply-side interventions are essential: dental dams need to be available where condoms are available — in pharmacies, clinics, and free distribution programs — not just online or in specialist shops. Manufacturers, the review argues, should improve product quality, address the taste and texture objections that appear repeatedly in the qualitative data, and include clear user instructions in packaging to raise self-efficacy. Third, sexual health education must incorporate dental dams explicitly, with practical information, not just naming them. The confusion between dental dams and female condoms, and the complete lack of familiarity with cling film as even an option, are education failures that targeted, practical campaigns can address. Crucially, those campaigns need to reach beyond the populations that currently dominate the literature. The seventeen included studies came almost entirely from Europe, Australia, North America, and Asia. No African populations were studied. No South American populations. And within the studied populations, most research targeted women who have sex with women, prisoners, and people living with HIV. Heterosexual populations are nearly absent from the evidence base. Kanmodi and colleagues call explicitly for policies that are "all-inclusive" and that reach both privileged and disadvantaged populations — because the structural barriers to dental dam access fall harder on people with fewer resources, and the geographic gaps in research mean that global public health guidance is being built on evidence from a narrow slice of the world. The core lesson from this review is a clean one. Oral sex is common enough globally that safer oral sex practice is a genuine public health issue. Dental dams and cling film exist as barrier options but remain almost entirely unknown, inaccessible, and unused across most populations studied. Attitudes are predominantly negative — not because the tools are inherently bad, but because product design, availability, and education have all failed to make them genuinely viable alternatives. And the most basic question — do they work — has never been answered by research. The path forward runs through efficacy studies, better products, universal distribution alongside condoms, and education campaigns designed around the real barriers documented in this evidence base, reaching populations and regions that the existing literature has largely ignored. The protection gap is not inevitable. It is a consequence of policy choices that can be unmade. This lecture was created by ennepō. Go to https://ennepo.ai to Discover, Create and Follow the latest research in your field. Read when you can. Listen when you want to.