...greater prevalence oral sex; though it was not until the 1970s that societal attitudes began to perceive it as acceptable for unmarried couples as well (Michael et al., 1994).

Thus it is a historical reversal that oral sex has become more common than intercourse among heterosexual, White, and better educated samples as well as a precursor to intercourse (Billy & Tanfer, 1993; Michael et al., 1994; Prinstein, Meade, & Cohen, 2003; Schwartz, 1999). In addition, oral sex and other noncoital activities have made the definition of "sex" variable. One study indicated that roughly 60% of a undergraduate sample (N = 599) did not regard oral sex as "sex" (Sanders & Reinisch, 1999), though a younger sample (ages 13-16) indicated that as much as 77% of a national sample endorsed oral sex as "sex" (NBC News/People, 2005). Other studies have indicated that a range of 10-30% of virgin samples (defined as having not engaged in intercourse) had engaged in oral sex or perceived oral sex as allowing one to maintain virginity (Herold & Way, 1983; Schuster, Bell, & Kanouse, 1996; Woody, Russell, D'Souza, & Woody, 2000; see studies summarized in Bruckner & Bearman, 2005; NBC News/People Magazine, 2005; Remez, 2000; Sanders & Reinisch, 1999).

The major viral and bacterial sexually transmitted infections (STIs) can also be transmitted via oral sex--these include human papillomavirus (HPV), herpes simplex virus, hepatitis B, gonorrhea, syphilis, Chlamydia, and chancroid, respectively (Edwards & Carne, 1998a, 1998b; Hawkins, 2001). The Centers for Disease Control (CDC; 2004a, 2004b, 2004c, 2004d) also validates transmission via oral sex for Chlamydia, herpes, gonorrhea, and syphilis. In addition, whereas herpes simplex virus type 2 has historically been found to infect the genital region, herpes simplex virus type 1, most commonly found in the region of the mouth, is now appearing in the genital region, with oral sex identified as the significant culprit (Cherpes, Meyn, & Hiller, 2005). Finally, Remez (2000) cited communication with Penelope Hitchcock, chief of the Sexually Transmitted Diseases Branch of the National Institute of Allergy and Infectious Diseases, who stated that HIV transmission was possible via oral sex, but that it is rare. Barrier methods, such as the male condom, dental dams, and plastic food wrap such as Saran[TM] wrap have been endorsed as protection during oral sex, though typically any type of sexual contact is strongly discouraged if any type of lesion or sore is evident (CDC, 2000; Palo Alto Medical Foundation, 2005; University Health Center, 2005).

Yet, despite the likelihood of STI-transmission via oral sex, the national survey of teens by NBC News/People Magazine (2005) found that only 30% used protection (such as a condom) all of the time. Forty-two percent never used any protection. Nonetheless, this is in great contrast to a previous study of youth aged 12-15 in which very few participants used any protection, though the samples were extremely small (Boekeloo & Howard, 2002).

In terms of incidence and frequency, earlier studies indicated a rise in oral sex among adolescents (Newcomer & Udry, 1985), university students (Woody et al., 2000; Grunseit, Richters, Crawford, Song, & Kippax, 2005), and adults in general (Laumann, Gagnon, Michael, & Michaels, 1994). Other research has indicated greater acceptability of oral sex among adolescents in comparison to intercourse (Halpern-Felsher, Cornell, Kropp, & Tschann, 2005). In the NBC News/People Magazine (2005) study, 12% of the teen respondents indicated that they had engaged in oral sex.

Regarding gender differences in frequency of oral sex behavior, studies from the 1980s and the early 1990s revealed no significant differences in the giving/receiving of oral sex between men and women overall (Michael et al., 1994), greater activity for cunnilingus (Haas, 1979, as cited in Newcomer & Udry, 1985; Newcomer & Udry, 1985; Schwartz, 1999), or greater activity for fellatio in the past month (Herold & Way, 1983). Are there currently gender differences in giving/receiving oral sex? Although the evidence is meager or anecdotal (McKay, 2004), it does indicate a potential trend of women giving oral sex more frequently to men as opposed to an equal interchange (Remez, 2000). The reasons for any of these trends, however, are purely speculative.

Few studies have addressed the motivations for engaging in oral sex, though others have addressed predicting oral sex behavior (Herold & Way, 1983). The NBC News/People Magazine (2005) study found that between 40-47% of their young sample felt that not needing to worry about pregnancy, meeting the right person, and the desire of the partner to engage in oral sex were major reasons for engaging in oral sex the first time. Anecdotal evidence, based on speaking with a number of high school classes (Barrett, 2004), has included motivations of curiosity, pleasure, pleasing one's partner, intimacy, pregnancy/intercourse avoidance, drunkenness, and as a means to reduce STI/HIV risk.

Studies of oral sex also have not consistently addressed the varying relationship contexts in which oral sex occurs. Herold and Way (1983) did partially address the relationship context. Their study of unmarried university women revealed high dating commitment as positively correlated with high frequencies of performing oral sex, indicating that oral sex was more likely to take place in serious relationships than in less serious ones. A decade later, a community survey of over 3,000 men also found that oral sex was also more likely to occur in more serious relationships (Billy & Tanfer, 1993). These findings, however, might be outdated and also did not elucidate the various types of relationships that can be perceived as serious.

In summary, oral sex is now perceived not only more casually than intercourse but also as something in which one can engage prior to intercourse, with greater frequency, and still potentially remain a virgin. The level of knowledge about STI transmission via oral sex and the varied methods of protection have not been thoroughly investigated. The motivations for oral sex are possibly varied. The earlier literature did not indicate any clear trends regarding gender differences in giving/receiving oral sex, though oral sex seems to have increased in frequency over the years among adults and adolescents. Past research has also indicated that oral sex is more likely to take place in serious relationships, but the types of relationships have not been specified.

Therefore, what questions as yet remain unanswered or unclear? First, it remains unclear how well the oral-sex STI risk is understood and, more importantly, how effectively people can protect themselves. In addition, the evidence is scarce on how often or how many virgins tend to engage in oral sex. The motivations for engaging in oral sex and any gender differences therein also need to be clarified. Finally, the specific types of relationships that today's young adults consider acceptable for oral sex are as yet unknown. In addition, it is unknown whether greater prevalence of oral sex implies that it is perceived as less intimate than intercourse.

Pursuing answers to these questions should yield important information regarding the health risk of oral sex, the potentially varying motivations between the genders for giving/ receiving oral sex, the type of relationships in which oral sex is likely to occur, and the frequency of oral sex in comparison to intercourse. All of these findings have implications for sex education classes, the Department of Health, the CDC, and other avenues (i.e., parents, media) that both assess and influence the sexual health of young men and women. People of all ages should be aware of their motivations for their sexual behavior (which could potentially lead to modifying unsafe behavior), the potential health implications, and how to protect their health when engaging in various sexual behaviors.

The current study addressed the following in a college-aged audience in the format of an anonymous, online survey: incidence of oral sex among virgins versus nonvirgins; the level of intimacy that is accorded oral sex; the type of relationship in which oral sex is typically given/received; overall frequency of giving versus receiving of oral sex between men and women; the most typical reason(s) for giving versus receiving oral sex--that is, for each particular respondent, not a general opinion of what most "think" is the typical reason; assessment of knowledge about transmission of STIs via oral sex; and whether and how often protection is used during oral sex.

Methods

Procedure

Between June and December of 2004, a sample of 2,147 college students at the University of Georgia aged 18 years or older completed an online survey about oral sex to achieve research participation credit. Only students in introductory psychology courses were invited to take the survey. Participants initially viewed an informed consent page that explained that intimate questions pertaining to oral sex would be the focus of the survey. They were informed that they would not be penalized for choosing not to take the survey or not finishing it, but they had to finish it to receive credit. Student consent was accounted for by their choice to proceed with the survey.

Once students completed the survey, they would click on an electronic button to submit their answers, which would also produce a pop-up page with feedback about their performance on the knowledge section of the survey. This page also contained a debriefing: "Please read the debriefing section below and then BE SURE TO CLICK ON THE "Click here to receive Research Participation Credit" button THAT FOLLOWS OR YOU WILL NOT RECEIVE CREDIT FOR YOUR PARTICIPATION. Although the answers to the survey were anonymous, students submitted their names to a separate database to receive credit after completing the survey. Every other week the researcher would download the name database and award students credit online through the university's online system. Thus, the data and the names were kept completely separate.

Measures

A survey was constructed to asses the nature, knowledge, and gender differences in oral sex behavior (see the Appendix). No identifying information was collected, only demographics. The variables were organized in the following domains:

Demographics. Participants provided information about their gender, race, sexual orientation, and age.

General sexual behavior/attitudes. General behavioral questions were asked regarding whether the participants had had intercourse before, whether the participants considered themselves virgins, and the number of intercourse partners in the past year and lifetime. Intercourse was defined as penetration by a sexual organ--the data indicate that participants correctly understood this definition to mean penetration of or by a sexual organ--see the Discussion section for complete explanation.

Oral sex. Survey items measured the intimacy of oral sex and intercourse on 5-point Likert-type scales (1 = not at all intimate and 5 = extremely intimate). Participants were asked how often they protected themselves while giving or receiving oral sex and what type of protection they used. They were given choices to select ("Check all that apply") as well as a text box and always had the option to choose that they did not engage in oral sex. "Check all that apply" was also offered for the type of relationship in which participants felt comfortable giving and receiving oral sex and the most typical reason for giving/receiving...

NOTE: All illustrations and photos have been removed from this article.



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