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A questionnaire on sexual attitudes and behavior was administered to first-year students at Macquarie University in Sydney every year from 1990 to 1999 (N = 4295 aged 18-19; 72.5% female). Responses to questions about experience of different sexual practices (tongue kissing, oral sex, and vaginal intercourse) with regular and casual partners were analyzed for trends. Over half of the students each year (on average 64% of the men, 57% of the women) had experience of oral sex or vaginal intercourse. More male than female students reported experience of each practice, especially with casual partners. Rates for female students increased significantly over the 10-year period for all practices except tongue kissing with a regular partner and vaginal sex with a casual partner; rates for male students were apparently steady. Results are consistent with evidence from other sources of an increase in the acceptability of oral sex (both fellatio and cunnilingus) in recent decades and of increasing similarity between young men's and women's reports of sexual experience.

Uppsatsen ämnar utföra en intersektionell analys av hur kvinnliga rappare diskuterar cunnilingus i sina texter. Utförandet av en intersektionell analys innebär att undersöka, beskriva och tolka någonting utifrån ett sociologiskt perspektiv som tar hänsyn till hur samverkan av olika sociala maktstrukturer skapar förtryck för olika samhällsgrupper. För denna analys innebär det att se på hur cunnilingus diskuteras av kvinnliga rappare i relation till deras kön, klass och etnicitet, för att se hur diskussionen påverkas av dessa sociala faktorer. Original-filen utbytt mot en censurerad version den 20 mars 2020. Fulltexten hade då laddats ner 1240 gånger.

sexually transmitted infection (STI) remains a major health problem in some parts of the world. This study aimed to determine the host and environmental factors the effect on the incidence of cervicitis on sex workers. The study was observational case-control design with consecutive sampling technique. Risk factor for cervicitis is a history of sexually transmitted infections (p=0,0001), have couple (boy friend) different gender (p=0,014, OR=4,4; CI95%=1,3-14,3), history of oral sex/cunnilingus (p=0,003, OR=6,8;CI95%=1,9-24,8), smokers (p=0,0001, CI95%=5,6; CI95%=2,4-13,1). Condom use last sex behavior is a protective factor affecting the incidence of cervicitis (p=0,0001, OR= 0,198; CI95 %=0,07- 0,5). The conclusion of this study is to prevent servisitis at-risk groups of commercial sex workers it should avoid from exposure of agents that cause sexually transmitted infections, does not have a spouse who is not authorized (girlfriend) that leads to sex behavior, avoid behaviors oral sex / cunnilingus, no smoke. At-risk behavior should use condoms for prevention servisitis

Background: Current information about numbers of other-sex partners, experiences of different heterosexual behaviours and the recent heterosexual experiences among a representative sample of Australian adults is needed. It is not known whether these practices have changed between 2001-02 and 2012-13. Methods: Computer-assisted telephone interviews werecompleted by arepresentative sampleof9963men and 10131womenaged 16-69 yearsfromall states and territories. The overall participation rate among eligible people was 66.2%. Results: Men reported more sexual partners than women, although the lifetime number of heterosexual partners reported by women increased significantly between 2001-02 and 2012-13. In 2012-13, 14.7% of men and 8.6% of women reported two or more sexual partners in the last year. Reporting multiple partners was significantly associated with being younger, being bisexual, living in major cities, having a lower income, having a blue-collar occupation and not being married. The proportion of respondents reporting ever having had oral sex or anal intercourse increased significantly since the last survey. At the last heterosexual encounter, 91.9% of men and 66.2% of women had an orgasm, oral sex was reported in only approximately one in four encounters and anal intercourse was uncommon. Conclusion: There were increases between 2001-02 and 2012-13 in partner numbers among women and in the lifetime experience of oral and anal sex. The patterns of heterosexual experience in Australia are similar to those found in studies of representative samples in other countries. Additional keywords: anal intercourse, Australia, contraceptive behaviour, cunnilingus, fellatio, heterosexuality, national survey, oral sex, orgasm, sexual behaviour, sexual practices.

This article explores the concept of a female gaze in so-called ‘hard core’ erotica, focussing on the recent erotic film, Romance (1999), written and directed by Catherine Breillat. Though given limited public release, Romance contains explicit sex scenes, including fellatio and cunnilingus, and may therefore be said to contain elements of ‘hard core’ cinema. The film depicts a woman's quest for erotic fulfilment, but unlike most previous treatments of this popular theme of male-centred erotic cinema (Just Jaeckin's Emmanuelle, for example), the point of view represented in this female-authored film appears to be unambiguously feminine. This feminine point of view is represented mainly by a voice-over conveying the heroine's thoughts and emotions, which aids identification of the audience with her on psychological, emotional and sexual levels. In spite of this feminine point of view, however, Romance demonstrates the difficulties involved in the successful modelling of a female gaze.

Rape is one of the fastest growing violent crimes in many parts of the world. Rape laws have been amended in most countries in an attempt to cope with the proliferation of this crime. Even though the legal definition of rape and the procedural laws have been amended, rape remains a serious problem in both the developed and developing nations. In some countries the offence of rape carries severe punishment sometimes even the death sentence. In many jurisdictions the term 'sexual penetration' is being used instead of 'sexual intercourse'. Sexual penetration includes sexual intercourse, anal intercourse, cunnilingus, fellatio or any other intrusions involving any part of a human body or of any object into the genital or anal opening of a person's body. In many countries rape and other sexual offences have been replaced with a series of gender neutral and graded offences with appropriate punishments. Medical examination can provide independent, scientific, corroborative evidence that may be of value to the court in arriving at a judgement. Doctors should have a clear understanding of different rape laws in order to apprectiate the various issues involved. Special knowledge, skill and experience are essential to conduct a good-quality medical examination. There is a dearth of trained forensic physicians in many Asian countries. However, managing a rape victim (survivor) goes for beyond proving the case in a court of law. There should be an adequate rehabilitation programme available to the victims to help them cope.

The sexual relations of expectant and young parents have been researched relatively often, but most studies are restricted to female participants, samples from the USA, a short postpartum period and a reductionist view of sexuality as equivalent to intercourse. The aim of this study is to gain more knowledge about sexual activity of German couples with regard to non-genital tenderness, French kissing, breast stimulation, manual-genital stimulation, cunnilingus, fellatio, vaginal intercourse, anal intercourse and masturbation during pregnancy and the first 6 months postpartum. As part of a larger longitudinal study, 60 women and men (30 couples) answered a newly developed Sexual Preferences Questionnaire (SPQ) which assesses sexual activity and enjoyment. The frequency of most heterosexual activities declined during pregnancy, reached almost zero in the first 3 months postpartum, and then began to increase; male masturbation remained relatively constant. Agreement between the two members of each couple was assessed and SPQ data were validated with other questionnaire data and interview data. The results are discussed with regard to limitations of the sample. Future research should broaden the range of questions investigated, the range of research methods applied (questionnaires and interviews) and the range of persons researched (both partners).

Sexual behaviors are associated with many genital infections, but the role of sexual variables as risk factors for Candida vulvovaginitis has not been clearly determined. To assess the association between sexual behaviors and other risk factors with the presence of Candida vulvovaginitis, we performed a case-control study comparing these potential risk factors in women with and without culture-documented Candida vulvovaginitis in two Midwestern community-based medical offices. Participants included 156 women with Candida vulvovaginitis and 92 controls, ages 18-60. Risk factors for Candida vulvovaginitis, including sexual and partnership behaviors, demographic data, past genital infections, exposures, and diet, were investigated using logistic regression. The presence of Candida vulvovaginitis was positively associated with recent cunnilingus (odds ratio [OR] = 2.22 for five times a month compared with no times, 95% confidence interval [CI] 1.36, 3.84), but was less likely in women who masturbated with saliva in the previous month (OR = 0.30 if masturbated five times vs. no times, 95% CI 0.09, 0.99). Other independent risk factors included knowing the sexual partner a shorter period of time (OR = 1.56 for 1 year vs. 5 years, 95% CI 1.16, 2.13) and lower milk ingestion (OR = 3.57 for no servings vs. two servings per day, 95% CI 2.00, 6.67). Increased number of sexual partners, early age at first intercourse, and increased frequency of intercourse are not related to risk.

Introduction of bacteria into the amniotic cavity has been associated with oral sex through an ascending infectious route. Previous reports have implicated both Capnocytophaga and Fusobacterium nucleatum via this process. We report a case of Streptococcus viridans intra-amniotic infection occurring at 25 weeks' gestation. Patient questioning revealed a close temporal relationship between the onset of symptoms and previous episodes of cunnilingus. The diagnosis of subclinical bacterial colonization of the amniotic fluid should be considered in patients presenting with preterm labour and no apparent aetiology. A history of recent cunnilingus may be associated with the presence of Streptococcus viridans in the amniotic fluid.

The sexual activities college students reportedengaging in prior to their first coital experience wereinvestigated. A volunteer sample of 311 students (120male and 191 female) completed a self-report anonymous questionnaire. Both males and femalesreported considerable precoital sexual experience.Although males reported more frequent activity thanfemales on all items of assessment, the difference between groups, with the exception ofmasturbation, was not significant. The majority of bothmales and females reported at least one experience, anda sizable minority reported considerably moreexperience, with cunnilingus and fellatio, risk behaviorsfor the transmission of STDs, prior to their firstcoitus. Attention is drawn to the dearth of informationon sexual activity prior to coital initiation. Given the potential risks of some of theseactivities, recommendations to further explore andaddress the precoital sexual behavior of adolescents aresuggested.

Although approximately 400 extant primate species are currently known to science, only one of them—Homo sapiens— acts as host to the virulent sexually transmitted infection (STI) called gonorrhea. From a comparative perspective, this is surprising, given that many non-human primates, such as macaques, baboons, chimpanzees, and bonobos, typically engage in multiple-partner copulations. Such mating patterns are expected to favor the genesis and spread of STIs (Anderson, Hessel, & Dixson, 2004; Nunn, Gittleman, & Antonovics, 2000). Thus, we are ledtoaskwhygonorrheashouldhavearisenonlyinhumanbeings. The hypothesis outlined here provides a possible explanation. Gonorrhea is caused by the gram-negative bacterium Neisseria gonorrhoeae, which infects the epithelial cells of mucous membranes, includingthosewhichlinetheurethra,vagina,pharynx,andrectum.Gonorrheamaythusbe transmittedviavaginal, anal, and oral sexualcontacts (Bancroft,2009;Holmeset al., 2008; Rogstad,2011).N.gonorrhoeaewasfirst isolatedin1879,byAlbert Neisser, but since that time scores of additional Neisseria species have been described (Bennett et al., 2012). The vast majorityof thesearenon-pathogenic,however,existingasharmless commensals in the nasopharynx (Liu, Tang, & Exley, 2015). Moreover, transfer of chromosomal genes has been shown to occur between some of these harmless Neisseria species and N.gonorrhoeae(MaynardSmith,Dowson,S Rogstad, Elengasinghe, & Powles, 2015). N.gonorrhoeae may thus be likened to an‘‘invasive species,’’ in the sense that its precursor was transferred from its originalhabitat in thepharynx tonovel sites in thegenitalia,where it is less well tolerated, and causes disease. Such transfers of the pharyngeal bacteria that were ancestral toN.gonorrhoeaemost likely occurred as a result of the practice oforalsex.Humanbeingsaremuchmorepronetoengageinsuch contacts thanarethenon-humanprimates.Althoughvariouskinds of genital investigation commonly precede copulation in the prosimians, monkeys, and apes (for review, see Dixson, 2012), recorded incidences of fellatio and cunnilingus are very rare, especially for animals living under natural conditions. Thus, human sexual behavior is unusual in this respect, which may explain why gonorrhea has arisen solely inHomo sapiens. Precisely when the disease originated is uncertain—whether in biblical times or in Europe during the Middle Ages (e.g., Boyd, 1955; Morton, 1977; Vertue,1953).Eitherway,itappearsthathumanityisstilladapting physiologically to this STI, and that N.gonorrhoeae, in turn, is rapidly evolving resistance to the antibiotics with which we attempt to curb its spread (Whiley et al., 2012).

OBJECTIVES: To review the literature on the role of oral sex in the transmission of non-viral sexually transmitted infections (STIs). METHOD: A Medline search was performed using the keywords oro-genital sex, and those specific to each infection. Further references were then taken from each article read. CONCLUSIONS: Oral sex is a common sexual practice between both heterosexual and homosexual couples. Oro-genital sex is implicated as a route of transmission for gonorrhoea, syphilis, Chlamydia trachomatis, chancroid, and Neisseria meningitidis. Other respiratory organisms such as streptococci, Haemophilus influenzae, and Mycoplasma pneumoniae could also be transmitted by this route. Fellatio confers risk for acquisition of infection by the oral partner. Cunnilingus appears to predispose to recurrent vaginal candidiasis although the mechanism for this is unclear, while a link between oro-genital sex and bacterial vaginosis is currently being studied. Oro-anal sex is implicated in the transmission of various enteric infections. In view of the increased practice of oral sex this has become a more important potential route of transmission for oral, respiratory, and genital pathogens.

Saliva plus DNA from a suspect is commonly encountered in sexual assault cases on bodily swabs. However, without background knowledge, the weight of this evidence is unknown. It may indicate the presence of saliva resulting from cunnilingus, or it may represent indirect transfer. In this study, females who refrained from cunnilingus donated 43 items of underwear and 19 vaginal swabs. The samples were subjected to Phadebas(®) , RSID(™) -Saliva and mRNA profiling and were subsequently DNA-profiled to determine the prevalence of background saliva in the female population. The results report that 15.8% of females who refrained from cunnilingus were positive for saliva and a further 10.5% also had DNA from unknown source(s). These findings of the rate of indirect transfer were evaluated with the Bayesian approach, and it was found that the evidence of saliva plus a high foreign DNA source adds moderately strong support to the allegation of cunnilingus.

Objective: To investigate, by use of the Amplicor PCR in a routine setting, the recovery rate of Chlamydia trachomatis in ano-rectal and pharyngeal swab samples obtained from males and females attending an STD clinic in relation to sexual practices, symptoms, and signs. Design: Data regarding sexual practices, and symptoms and signs related to the rectum and pharynx, were obtained from 196 females and 208 males, including 31 homosexuals and eight bisexuals. Swab samples were obtained from the urethra, rectum, and pharynx from all the patients. An additional endocervical swab sample was obtained from the females. Methods: All samples were analysed by the Amplicor PCR (Roche). Setting: Rudolph Bergh's Hospital, a clinic for sexually transmitted diseases situated in the centre of Copenhagen, Denmark. Results: The overall prevalence of urogenital G trachomatis infection was 9.2% (37/404). The specificity of the Amplicor PCR was 100% for both ano- rectal and pharyngeal swab samples. In females three (13%) of the 23 infections were detected only by testing an ano-rectal or throat swab sample. In homosexual males two (67%) of three infections were detected only by the ano-rectal swab sample. Ano-rectal intercourse without use of condom was reported by 44% of females and by 52% of homosexual males. Fellatio without condom use was reported by 91% of females, and 80% of heterosexual males practised cunnilingus. Pharyngeal infection, however, occurred only in females, and the presence of pharyngeal symptoms or signs seemed predictive for pharyngeal G trachomatis infection, for which the time of incubation or colonisation exceeded 3 months. The presence of ano-rectal signs or symptoms was not predictive for an ano-rectal G trachomatis infection. Conclusion: The Amplicor PCR can be used on ano-rectal and pharyngeal swab samples. Ano- rectal swab samples should be obtained in females and homosexual males at high risk of being infected. Pharyngeal samples should be taken in females at high risk of being infected, especially when pharyngeal signs or symptoms are present.

Although popular media have addressed the issue of women pretending orgasm during sexual intercourse, the research literature on the phenomenon is sparse. In the current study, 161 young adult women provided data regarding lifetime sexual experience, objective and subjective physical attractiveness, sexual attitudes (erotophobia-erotophilia), sexual esteem, and general tendencies toward self-monitoring of expressive behavior in social situations. Overall, more than one-half of the women reported having pretended orgasm during sexual intercourse. In univariate analyses, the "pretenders" and "non-pretenders" did not differ in experimenter-rated facial attractiveness, self-rated body attractiveness, or general self-monitoring. However, pretenders were significantly older; viewed themselves as facially more attractive, reported having had first intercourse at a younger age; reported greater numbers of lifetime intercourse, fellatio, and cunnilingus partners; and scored higher on measures of sexual esteem and erotophilia. In multivariate analyses, only sexual esteem was uniquely related to having pretended orgasm. The findings are discussed with regard to possible explanations and implications, as well as directions for future research.

Rape of women by men has occurred throughout recorded history and across cultures and religions. It is a crime against basic human right and a most common crime against women in India. In this article, rape is discussed from legal and mental health perspective. In India 'rape laws' began with enactment of Indian Penal Code in 1860. There have been subsequent amendments and the main issue of focus remained the definition of 'rape and inclusion of 'marital rape' in the ambit of rape. Law Commission Reports related to rape and the psychological impacts of rape have been discussed.

We secured data from 243 men in committed, sexual, heterosexual relationships to test the sperm retention hypothesis of oral sex. We predicted that, among men who perform cunnilingus on their partner, those at greater risk of sperm competition are more likely to perform cunnilingus until their partner achieves orgasm (Prediction 1), and that, among men who ejaculate during penile-vaginal intercourse and whose partner experiences a cunnilingus-assisted orgasm, ejaculation will occur during the brief period in which female orgasm might function to retain sperm (Prediction 2). The results support Prediction 1 but not Prediction 2. We discuss limitations of the current research and discuss how these results may be more consistent with alternative hypotheses regarding female orgasm and oral sex.

We observed a total of 57 incidences of copulation in a colony of the Indian flying fox, Pteropus giganteus, over 13 months under natural conditions. The colony consisted of about 420 individuals, roosting in a Ficus religiosa tree. Copulations occurred between 07.00 h and 09.30 h from July to January, with more occurring in October and November. Initially males groomed their penis before approaching a nearby female. Females typically moved away and males followed. When the female stopped moving, the male started licking her vagina (cunnilingus). Typically each bout of cunnilingus lasted for about 50 s. In 57 out of 69 observations, the male mounted the female and copulated. The duration of copulation varied from 10 to 20 sec. After completion of copulation, the male continued cunnilingus for 94 to 188 sec. The duration of pre-copulatory cunnilingus and copulation was positively correlated whereas, the duration of pre- and post-copulatory cunnilingus was negatively correlated. Apart from humans, oral sex as foreplay prior to copulation is uncommon in mammals. Another pteropodid bat, Cynopterus sphinx exhibits fellatio with females licking the penis of males during copulation. It appears that bats, especially pteropodids perform oral sex, either cunnilingus or fellatio, possibly for achieving longer copulation.

OBJECTIVES: The purpose of this study was to determine whether high school-aged virgins engage in sexual practices that can transmit sexually transmitted diseases, including the human immunodeficiency virus (HIV). METHODS: Data were collected from an anonymous self-administered survey of 2026 urban students in 9th through 12th grades. RESULTS: Forty-seven percent of adolescents were virgins (42% of male adolescents and 53% of female adolescents). Of those who were virgins, 29% and 31% reported that, during the prior year, they had engaged in heterosexual masturbation of a partner and masturbation by a partner, respectively. The corresponding rates for heterosexual fellatio with ejaculation, cunnilingus, and anal intercourse were 9%, 10%, and 1%. Homosexual sexual activities were rare. Condom use for fellatio was also rare. Level of risk of virgins' sexual activities was associated with illicit substance use and other non-sexual risk behaviors, even after demographic variables had been controlled. CONCLUSIONS: Few high school-aged virgins engaged in anal intercourse, but many engaged in other genital sexual activities. Some of these activities can transmit disease, and all can indicate a need for counseling about sexual decision making, risk, and prevention.

A recent focus of interest has been on the functional significance of genital licking (fellatio and cunnilingus) in relation to sexual selection in Pteropodid bats. In the present paper, a form of fellatio in wild Bonin flying foxes, Pteropus pselaphon, performed between adult males has been reported. During the mating season, adult flying foxes roost in same-sex groups, forming ball-shaped clusters which provide warmth. The female clusters may also contain a few males. Unassociated with allogrooming, same-sex genital licking occurred among males in the all male clusters. As such, male-male fellatio can be considered as homosexual behavior, two functional explanations could account for this behavior; the social bonding and the social tension regulation hypotheses suggested in a previous review. Given that neither the simpler alternative that in all male groups such fellatio may represent misdirected sexual behavior, nor the two previously proposed functional hypotheses were supported by the data, I propose another functional hypothesis. Homosexual fellatio in this species could help males solve inconsistent situations in the roost when there are conflicts between cooperative behavior for social thermoregulation and competition for mating.

Objectives The development of safer sex recommendations for women who have sex with women (WSW) remains challenging given a limited understanding of sexual behaviour between women. The present study was conducted in order to investigate the sexual repertoires of WSW and the safer sex methods they use to reduce the likelihood of sexually transmitted infection acquisition. Methods An online survey targeted towards women with desire, attraction or previous sexual behaviour with women was distributed globally. Women (N=3116) who engaged in at least one sexual act with a woman in the previous year and were currently living in the USA, UK, Canada or Australia were included in the present study. Questions were based upon previously validated items in nationally representative studies. Results Participants indicated a wide diversity of sexual behaviours with the majority of women reporting a history of genital rubbing (99.8%), vaginal fingering (99.2%), genital scissoring (90.8%), cunnilingus (98.8%) and vibrator use (74.1%). Barrier use was reported by a minority ( Conclusions The variety of sexual acts reported by the sample points to the need for the development of more contextually appropriate sexual health guidelines for WSW.

Introduction Questions have recently arisen in the popular press about the association between specific sexual behaviors, namely, fellatio and cunnilingus, with head and neck cancers. Although there has been an overall decline in the incidence of head and neck cancers over the past 25 years, there has been a shift in the distribution of these cancers toward a particular type known as oral squamous cell carcinomas (OSCCs), and a younger demographic. These particular cancers, OSCCs, have been shown to be associated with the human papillomavirus (HPV). Several researchers have suggested that this shift in the epidemiology of head and neck cancers might be attributable to changing sexual practices. While this speculation has caught on in the popular press, there are several interesting contradictions in the existing evidence that suggest this conclusion might be premature and overreached. Aim The intent of this article is to help clarify the issues so that sexual medicine professionals can give accurate and up‐to‐date information to their patients. Main Outcome Measures This is a review article; no outcome data are reported. This is a review article; no measures were collected. Methods Pubmed search on HPV, oral sex, oral cancers, and OSCCs. Results One hundred ninety‐six articles on HPV were found; 63 articles on oral sex, 55 on oral cancer, and 5 articles on OSCCs were identified as relevant. Conclusions HPV infections occur commonly and are usually cleared within 18 months, thus HPV infection should not be a cause for concern among monogamous couples with a rich and varied sex life as long as the sexual system remains closed and other immune compromising factors are not present. HPV becomes a concern in the context of immune system compromise and infection persistence. Factors contributing to immune system compromise, HPV persistence, and oncogenesis are reviewed. Rosenquist SE. Is oral sex really a dangerous carcinogen? Let's take a closer look. J Sex Med 2012;9:2224–2232.

Surprisingly little is known about oral sex experiences among emerging adults, including the motives behind their participation in this sexual activity. The current study examined the characteristics of emerging adults’ most recent oral sex experience. A total of 431 young people (M age = 21.7 years; 71.7% female) completed an on-line survey assessing their sexual history, context (partner type, co-occurring sexual behaviors), and motives (physical, emotional, goal attainment, and insecurity) for engaging in their most recent heterosexual oral sex interaction. The majority of oral sex encounters occurred within the context of a committed relationship and during an interaction that also included intercourse. Cunnilingus was rare unless reciprocated with fellatio. Overall, both males’ and females’ reports indicate that they were motivated to engage in oral sex by sexual desire and attraction to their partner, or to enhance an emotional connection with their partner. Insecurity and goal attainment motives were uncommon. Males reported more physical motives than did females, and females reported more emotional and insecurity motives than did males. The findings provide insights into youths’ oral sex experiences, and make clear how essential it is to understand the broader sexual and partnership context in which a given sexual activity occurs. These findings have implications for policies aimed at the development of effective sexual health education programs.

Introduction Recent studies have uncovered multiple markers of vaginal orgasm history (unblocked pelvic movement during walking, less use of immature psychological defense mechanisms, greater urethrovaginal space). Other markers (perhaps of prenatal origin) even without obvious mechanistic roles in vaginal orgasm might exist, and a clinical observation led to the novel hypothesis that a prominent tubercle of the upper lip is such a marker. Aims To examine the hypothesis that a prominent tubercle of the upper lip is associated specifically with greater likelihood of experiencing vaginal orgasm (orgasm elicited by penile–vaginal intercourse [PVI] without concurrent masturbation). Methods Women (N = 258, predominantly Scottish) completed an online survey reporting their frequencies of various sexual activities and corresponding orgasms, age, and the prominence of the tubercle of their upper lip. Social desirability response bias was also assessed. Main Outcome Measures Multivariate associations of lip tubercle prominence with vaginal orgasm (ever and past month consistency) and with orgasm by other means. Results A prominent and sharply raised lip tubercle was associated with greater odds (odds ratio = 12.3) of ever having a vaginal orgasm, and also with greater past month vaginal orgasm consistency (an effect driven by the women who never had a vaginal orgasm), than less prominent lip tubercle categories. Lip tubercle was not associated with social desirability responding, or with orgasm triggered by masturbation during PVI, solitary or partner clitoral or vaginal masturbation, vibrator, or cunnilingus. Conclusions The results are discussed in light of the unique nature of vaginal orgasm and the possibility of prenatal developmental influences.

Little normative data exist about the frequency and variety of sexual behavior of injection drug users. Sexual behaviors of a group of 313 injection drug users (225 men and 88 women) were assessed by a structured interview at the start of an acquired immune deficiency syndrome prevention project. Celibacy was reported by 12.3% of men and 26.9% of women in the year before the initial interview. Male injection drug users who had been sexually active reported a mean number of 4.61 (median, 2.0) female sexual partners in the previous year; sexually active women reported a mean number of 5.28 (median, 1.0) male sexual partners. Sexually active men and women reported median condom use frequency at 0% of vaginal intercourse events (mean for men, 10.31%; mean for women, 14.48%). Male injection drug users who reported using drugs to help them relax for sex, to enhance sexual performance, or to meet sexual partners reported greater frequency of anal intercourse, fellatio, and cunnilingus, less relative frequency of vaginal intercourse, more sexual partners, and greater involvement in being paid for sex and paying for sex than did men who did not report using drugs to enhance sex. Men who used drugs to enhance sex also reported higher frequency of use of a number of different drug classes than men who did not use drugs to enhance sex. For women, using drugs to enhance sex was related to greater frequency of anal intercourse and having more sexual partners. Implications for treatment of drug abusers and future research are discussed.

Theoretical and empirical linkages of adult women's sexual interest and sexual behaviors are relatively well-established, but few data address similar issues in adolescent women. This paper reviews data from published reports of associations of adolescent women's sexual interest and various sexual behaviors. All of the papers reported data collected from a single longitudinal cohort of young women. The primary source of data collection was daily diaries, allowing close temporal pairing of sexual interest with sexual behaviors. Young women's sexual interest on a given day was consistently and independently associated with sexual activity on that day, whether the behavior was first lifetime coitus, coitus, fellatio, cunnilingus, anal intercourse, or coitus during menses. We also found no evidence of influence of hormonal contraceptives on young women's sexual interest. Taken together, these data demonstrate the relevance of sexual interest as a key factor in young women's sexuality and sexual behavior.

Research examining oral sex during adolescence tends to investigate only potential negative consequences without considering its place in sexual development or distinctions between cunnilingus and fellatio. Using retrospective reports from 418 undergraduate women, we examined the relations among young women's ages of initiation of both cunnilingus and fellatio and sexual motives, experiences of sexual coercion, and indicators of psychological functioning. Age at cunnilingus initiation was unrelated to sexual coercion or psychological functioning; however it was related to engaging in sex for personal stimulation and gratification (personal drive motive) and to feel agentic, assertive, and skillful (power motive). Age at fellatio initiation was related to feelings of inferiority compared to others and a devaluing of the self (interpersonal sensitivity). Findings challenge the unilateral assumption that all adolescent sexual activity is negative and indicate the need for future research distinguishing between cunnilingus and fellatio.

A survey was carried out of sexual assault cases submitted to the Metropolitan Police Forensic Science Laboratory during 1988 and 1989. There were 104 cases with male victims, and 1403 with females. In the all-male offences, fellatio was reported in 34%; nearly two-thirds of the acts were by the offender, one-third by the victim. In the offences on females, oral-genital acts were alleged in 22%, 78% of which were fellatio, and 22% cunnilingus. The majority of offenders were white. The few Afro-Caribbeans studied rarely performed oral sex on males or very young females.

Background: Dental dams have been distributed to women prisoners for protection against HIV and other sexually transmissible infections (STIs) in some Canadian and Australian prisons for over a decade. However, we do not know whether they serve any useful public health purpose. Objective: To determine how dental dams are used in women’s prisons in New South Wales (NSW), Australia. Method: Using quantitative and qualitative methods, we investigated women’s sexual practices with a focus on how dental dams are used in NSW prisons. Results: Although 71 of the 199 (36%) women reported having had sex with another inmate, with oral sex involved in most encounters, only eight (4%) had ever used a dental dam. The main sources of STI transmission risk among women prisoners were oral sex, manual sex and sharing dildos. Furthermore, sharing razors could also allow the transmission of blood-borne viruses, which could occur during sex in the presence of cuts or menstrual fluid. The high rates of hepatitis B and C among incarcerated women compound this risk. Conclusion: Dental dams are not widely used by women prisoners and we question their utility in women’s prisons. Oral sex is an important risk factor for acquisition of herpes simplex virus type 1, but most women in NSW prisons (89%) are already infected. Condoms and latex gloves may have more use. Condoms could be used as a barrier on shared dildos and sex toys, while latex gloves could be used to protect cut and grazed hands from vaginal and menstrual fluids.

Twenty-four U.S. states have enacted HIV exposure laws that prohibit HIV-positive persons from engaging in sexual activities with partners to whom they have not disclosed their HIV-status.1 From a public health perspective, HIV serostatus exposure laws can be viewed as structural interventions that seek to limit the spread of HIV by acting at the policy level.2 A central premise of these laws is that informed partners are more likely to protect themselves by declining sex, by substituting less risky activities for higher-risk ones, or by using condoms, than are uninformed partners. However, the effectiveness of these laws at preventing HIV transmission is not known.3 There is little standardization among existing HIV exposure laws, which vary substantially with respect to the sexual activities that are prohibited without prior serostatus disclosure.4 Among the strictest laws are those in Arkansas, Michigan, New Jersey, and Ohio which mandate disclosure prior to almost any type of sexual contact.3 Activities requiring prior serostatus disclosure include “sexual intercourse, cunnilingus, fellatio, anal intercourse, or any other intrusion, however slight, of any part of a person's body or of any object into the genital or anal openings of another person's body, but emission of semen is not required.”6 California's law is the least restrictive HIV exposure statute. The law criminalizes undisclosed exposure to HIV only when the HIV-positive person engages in unprotected anal or vaginal sex with an uninformed partner and does so intending to infect the partner.7 The California law offers HIV-positive persons a variety of choices for lawful sexual expression: they can either disclose their HIV status, use condoms during vaginal or anal intercourse, or engage in less risky sexual activities. The effectiveness of HIV exposure laws in reducing HIV transmission risk critically depends on the extent to which HIV-positive persons comply with these laws and the extent to which compliance with the law reduces HIV transmission risk. These two factors, in contrasting measure, are in turn dependent on the specific sexual activities that are prohibited, in the absence of disclosure, by a particular HIV exposure law. Compliance is likely to be greatest when statutes provide multiple options for lawful sexual expression with a partner, such as the following actions: engaging in alternatives to anal or vaginal intercourse, using condoms for vaginal or anal sex, or disclosing their positive serostatus to prospective sex partners and negotiating a level of risk that is acceptable to both partners. The more options individuals have, the easier it should be for them to comply with the law. Conversely, because condom use is not 100% effective8 and because oral sex is not entirely safe,9 less restrictive laws that permit condom-protected vaginal and anal intercourse and/or oral sex without disclosure might be less effective in preventing HIV transmission than stricter laws that prohibit these activities. No empirical data are available regarding the effectiveness of HIV serostatus exposure laws. It is not known whether, in fact, HIV exposure laws are effective at reducing HIV transmission risk, or whether stricter laws are more or less effective than more flexible laws. We developed a relatively simple analytic framework for evaluating the HIV prevention effectiveness of HIV exposure laws and applied this framework to two general classes of exposure laws: “strict” exposure laws that require serostatus disclosure prior to any sexual activity and more “flexible” laws that allow exemptions for condom-protected intercourse or other low-risk activities. We were particularly interested in identifying the following: (a) the circumstances in which each type of law would be more effective at reducing HIV transmission risk than the no-law alternative, and (b) determining the conditions under which flexible laws would be more effective than strict laws, and vice versa. Flexible laws always reduce transmission risk, and do so to a greater extent than do strict exposure laws when post-disclosure sex is riskier than low-risk sex.

Purpose Little is known about factors associated with the day-to-day selection and orchestration of sexual repertoire among adolescent women. Analyzing differences in adolescent women's sexual activity may augment both the clinical and behavioral understanding of sexuality development and sexual decision making, and may yield important points to enhance existing programs for prevention of sexually transmitted infection or pregnancy. Methods Adolescent women ( N = 387, aged 14–17 years at enrollment) were recruited from primary care adolescent clinics serving primarily lower- and middle-income patients. Data were taken from daily sexual diaries. A four-category outcome variable, using generalized estimating equation multinomial logistic regression assessed the likelihood of specific sexual behaviors on a given day: none (abstinence), non–coital-only, coital-only, and dual noncoital/coitus. Separate models were analyzed for fellatio, cunnilingus, and anal sex. Predictor variables included age, menstrual bleeding, alcohol or marijuana use, positive or negative mood, recent coitus, recent noncoital sexual activity, partner support or negativity, sexual interest, feeling in love, time of the week, and same-day noncoital behaviors. Coital-only sexual behavior was used as the reference category. Results Among adolescent women, abstinence is prevalent on the majority of days. When sexual activity does occur, coital-only activity is most common; however, noncoital behaviors alone and/or in tandem with coitus are not rare. Conclusions Differing associations of intrapersonal, partner and situational variables with specific types of day-to-day sexual activity underscores a complex sexual repertoire which may be insufficiently examined with a simple focus on coital risk.

In order to examine factors associated with orgasm in heterosexual encounters, we analyzed data from the Australian Study of Health and Relationships, a national telephone survey of sexual behavior and attitudes and sexual health knowledge carried out in 2001-2002 with a representative sample of 19,307 Australians aged 16 to 59. Respondents were asked whether at their last sexual encounter they gave or received manual stimulation and oral sex, had vaginal intercourse or anal intercourse, and whether they had an orgasm. Vaginal intercourse was the dominant practice: 95% of encounters included it. Of the 64 possible combinations of these practices, 13 account for 93% of encounters: vaginal intercourse alone (12%), vaginal + manual stimulation of the man's and/or woman's genitals (49%), and vaginal intercourse + manual + oral (32%). Encounters may also have included other practices. Men had an orgasm in 95% of encounters and women in 69%. Generally, the more practices engaged in, the higher a woman's chance of having an orgasm. Women were more likely to reach orgasm in encounters including cunnilingus. This is the first large-scale empirical study worldwide to link specific practices with orgasm. Demographic and sexual history variables were comparatively weakly associated with orgasm.

Objective: Although numerous cross-sectional studies have identified herpes simplex virus type 1 (HSV-1) as an important genital pathogen, the specific sexual activities associated with HSV-1 infection are not well delineated. Our objective was to identify demographic and behavioral variables in women associated with the prevalence and acquisition of HSV-1. Study: From 1998 through 2000, we enrolled 1207 nonpregnant 18- to 30-year-old women from 3 Pittsburgh, Pennsylvania, area health clinics in a prospective cohort study. Serum from the women was tested each visit for the presence of type-specific HSV-1 antibodies. Results: At enrollment, HSV-1 serum antibodies were detected in only 38% of women ≤20 years of age. Black race, ≤12 years education, older age, and a history of at least 5 lifetime male sex partners were independently associated with the prevalence of HSV-1. In longitudinal analyses, women who had vaginal intercourse were more likely than sexually inactive women to acquire HSV-1 (6.8 vs. 1.2 cases per 100 woman-years of follow up; P = 0.05). Similarly, women who only had receptive oral sex, without vaginal intercourse, were also more likely than sexually inactive women to acquire HSV-1 (9.8 vs. 1.2 cases per 100 woman-years of follow up; P = 0.04). Conclusions: Receiving cunnilingus and vaginal intercourse are important risk factors for the acquisition of HSV-1 among young women. Genital herpes prevention strategies will need to consider both the increased susceptibility for HSV-1 acquisition that young adults now have at sexual debut and the important contributions of HSV-1 to the burgeoning genital herpes epidemic.

Objective: The objective of this study was to determine concordance in sex partner reports of frequency of vaginal and oral intercourse and condom use. Study Design: Self-reported behaviors among 112 women treated for urinary tract infection (UTI), sore throats, or receiving birth control at a student health service were compared with that of their current sex partner. Results: Correlation was excellent for frequencies of vaginal intercourse (r = 0.88), cunnilingus (r = 0.72), fellatio (r = 0.76), and condom use (r = 0.86), but women with UTI compared with women without UTI reported greater frequency of sexual activity than their sex partner. This effect overwhelmed the modest increases in correlation associated with duration of relationship and marital status. Conclusions: Women with genitourinary symptoms may over-recall frequency of sexual behavior compared to women without these symptoms. Knowing the extent of this recall bias will assist in the interpretation of data and appropriate correction of parameters when included in prediction models.

The sexual relations of parents at the postpartum stage have been researched relatively often, but still there exist serious research deficits (for example, neglect of male partners, of the later postpartum stages beyond the third month, and neglect of sexual feelings, enjoyment and orgasm). The aim of this study was to gain more knowledge about German couples' sexual enjoyment and orgasm with regard to non-genital tenderness, French kissing, breast stimulation, manual-genital stimulation, cunnilingus, fellatio, vaginal intercourse, anal intercourse and masturbation at seven months postpartum. As part of a larger longitudinal study 60 women and men (30 couples) answered a newly developed Sexual Preferences Questionnaire (SPQ), which assesses sexual activity and enjoyment. Descriptive data about sexual enjoyment, sex/gender differences and perceptual differences between self-report and reports of partners' enjoyment are analyzed and SPQ data are validated with interview and other questionnaire data (PFB-tenderness). Both genders find the same activities most pleasant (tenderness, vaginal intercourse, receiving manual-genital stimulation) and most exciting (intercourse, receiving manual-genital and oral-genital stimulation) and reach orgasm most easily through intercourse, masturbation and receiving manual-genital stimulation. But men generally describe a higher sexual enjoyment and overestimate their partners' enjoyment, especially with regard to female orgasm through intercourse. The results are critically discussed with regard to limitations and strengths of the sample and the method.

Many cases of mucopurulent cervicitis (MPC) are idiopathic and cannot be attributed to the known cervical pathogens Neisseria gonorrhoeae, Chlamydia trachomatis, or herpes simplex virus. Because Mycoplasma genitalium is associated with nongonoccocal urethritis in men, its role in MPC, the corresponding syndrome in women, was investigated. Archived cervical specimens from women recruited in the Harborview Sexually Transmitted Disease Clinic in Seattle from 1984 to 1986 were tested, using polymerase chain reaction, in a study that identified other causes of and risk factors for MPC. M. genitalium was detected in 50 (7.0%) of 719 women. Young age, multiple recent partners, prior miscarriage, smoking, menstrual cycle, and douching were positively associated with M. genitalium, whereas bacterial vaginosis and cunnilingus were negatively associated. After adjustment for age, phase of menstrual cycle, and presence of known cervical pathogens, women with M. genitalium had a 3.3-fold greater risk (95% confidence interval, 1.7-6.4) of MPC, which suggests that this organism may be a cause of MPC.

Background Oral sex is a common sexual practice in the United States; in 2002, almost 90% of sexually active adults ages 20–44 and over half of teens 15–19 years reported having had oral sex with an opposite sex partner. Oral sex is thought by some men who have sex with men to have lower risk for HIV acquisition, and is a prevalent practice in this population. However, the risk of acquiring a given sexually transmitted infection (STI) from oral sex may depend on a number of factors, including the specific STI, particular oral sex practice, prevalence of the STI in the population, and the number of oral sex acts performed. It is difficult to quantify the risk of getting an STI from a specific type of oral sex activity, or compare risks due to specific sex acts, because most people who have oral sex also have vaginal and/or anal sex. Methods In order to develop public health messages on oral sex and STI risk, we performed a review of the scientific literature to assess the state of current knowledge for risks of seven STIs (including HIV) and six oral sex practices: insertive and receptive fellatio, cunnilingus, and anilingus. Approximately 200 publications between 1979 and 2010 were reviewed; only 65 reported novel findings for one or more of these 42 potential associations. Results The clearest evidence of risk was found for syphilis (all oral sex practices), chlamydia (insertive and receptive fellatio; receptive anilingus), gonorrhoea (insertive and receptive fellatio), herpes (insertive fellatio; receptive cunnilingus), and HIV (receptive fellatio). For example, for pharyngeal gonorrhoea 4 of 4 studies reported association with receptive fellatio; 1 of 1 study found none for insertive anilingus. Other STI and oral sex associations were less well-studied, or have not been documented. No reports allow direct per-contact estimates, but some facilitate comparisons with non-oral types of sexual contact. A number of studies did not specify whether ejaculation or use of barrier protection was assessed. Conclusions All oral sex practices are associated with risk of transmission of one or more STIs; however the relations between specific oral sex practices and risk of infection are not well-characterised for several STIs. Despite this, it is important to formulate appropriate public health messages regarding oral sex and STI risk. Future studies should clearly distinguish between specific oral sex practices and consider these factors in sample size determination.

Objectives: Little is known about involuntary passage of air from the vagina, also known as vaginal wind, garrulous vaginalis, and other slang terms. Similarly, minimal data exist regarding the potential association between abdominal wall striae and pelvic organ prolapse (POP). The objective of this study was to describe the presence of vaginal wind and striae in patients with and without POP. Materials and methods: This was an IRB approved cross-sectional study of women R18 years seeking care at a single academic institution between December 2012 and August 2013. We excluded women with rectovaginal fistulae, prior POP or incontinence surgery, pregnancy, and the inability to complete forms. After obtaining informed consent, all patients completed a questionnaire about vaginal wind and striae, the Pelvic Floor Distress Inventory Short Form (PFDI-20), and the revised Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-IR). Additionally, POP-Q data, mid-vaginal width, and quantification of abdominal striae were recorded. Women were dichotomized into normal support (POP-Q stage 0-1) or POP (POP-Q stage 2-4) groups for analysis. Forty-six patients were needed in each group to detect a 13% difference in the prevalence of vaginal wind between groups with an a of 0.05 and power of 80%. Results: One hundred thirty-two patients were approached for participation. One hundred twenty-three patients (93%) agreed to participate, of which 110 (83%) completed study questionnaires. The mean age was 55.5 years and mean BMI was 27.5. The majority were white (65%), married (73%), sexually active (71%), and had a college education (76%). Fifty-one of 110 patients (46%) had normal support while 59/110 (54%) had POP. Those with POP had more vaginal deliveries (mean 2.4 vs. 1.3, p \ 0.001). There was no difference in medical comorbidities, smoking status, or steroid use between groups (p > 0.05 for all). Overall, 76/110 (69%) women experienced vaginal wind an average of 2.3 times per week and this was not statistically significant between groups (p = 0.47). Ninety-nine percent of women with vaginal wind experienced it during intercourse. Other activities associated with vaginal wind included cunnilingus (45%), digital stimulation (17%), jogging (45%), and sit-ups (44%). Sixty-four percent of women were at least somewhat bothered by vaginal wind, although only 22% reported a negative effect on quality of life. Women with vaginal wind had a longer mean vaginal length (9.5 vs. 8.8 cm, p = 0.004) and better apical support than those without vaginal wind (C -5.1 vs. -3.0 cm, p = 0.02). There was no difference in midvaginal width or other POP-Q points (p > 0.05 for all). Sixty-five of 110 (59%) women had striae: 23/51 (45%) with normal support and 42/59 (71%) with POP (p = 0.006). Women with POP were more likely to have striae compared to women with normal support, adjusting for skin color and smoking status (OR = 2.5, 95% CI, 1.036.06, p = 0.04). Conclusion: Vaginal wind is a common and bothersome complaint among women with and without POP and is associated with a longer total vaginal length and better apical support. Women with POP are more likely to have striae. Future studies are needed to further investigate these findings with regard to the impact on care-seeking and surgical intervention. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS

The History & Development of Clinical Forensic Medicine Worldwide: Introduction Historical References: Late 18th Century Onwards Contemporary Clinical Forensic Medicine Clinical Forensic Medicine Around the World Conclusions, Jason Payne-James. Fundamental Principles: Introduction: Ethical Principles Consent: Requisites For Consent: Capacity, Understanding, Risks and Warnings, Voluntary Agreement Incompetent Adult Patients Age of Consent Intimate Samples, Intimate Searches Video and Audio Recordings, Recording Telephone Calls Emergencies Confidentiality: Death and Confidentiality Detention and Confidentiality Exceptions to the General Duty of Confidentiality: The Patient's Permission The Patient's Best Interests The Public Interest, Interest of Others,Violent or Dangerous Patients Medical Teaching, Research and Audit Judicial and Statutory Exceptions Notekeeping Access to Health Records Preparation of Reports Attendance at Court: Demeanor in Court The Duties of Expert Witnesses Pitfalls, Roy N.Palmer. Sexual Assault Examination: Introduction Basic Principles of the Medical Examination: Immediate Care Timing of the Examination Place of the Examination Consent Details of the Allegation Medical and Sexual History Nature of the Examination: General Examination Ano-Genital Examination Ownership and Handling of Photodocumentation Basic Principles of the Forensic Analysis: Collection of Forensic Samples Packaging & Continuity Analysis Skin: Forensic Evidence: Method of Sampling Forensic Analysis Persistence Data Medical Evidence Hair - Head and Pubic: Forensic Evidence: Method of Sampling Forensic Analysis Persistence Data Medical Evidence Nails: Forensic Evidence: Method of Sampling Forensic Analysis Oral Cavity: Fellatio: Definition Frequency Legal Implications Forensic Evidence Medical Evidence Cunnilingus and Anilingus: Definitions Frequency Legal Implications Forensic Evidence Medical Evidence Female Genitalia: Frequency Legal Implications Anatomy Development Forensic Evidence: Method of Sampling Forensic Analysis Persistence Data Medical Evidence: Examination Methods Injuries Male Genitalia: Anatomy and Physiology: Penile Size Erections Production of Semen Forensic Evidence: Method of Sampling Forensic Analysis Persistence Data Medical Evidence Perianal Area and Anal Canal: Definitions Frequency: Consensual Non-Consensual Legal Implications Anatomy and Physiology: Anus Perianal Area Anal Canal Rectum Anal Sphincters and Faecal Incontinence Forensic Evidence: Method of Sampling Forensic Analysis Persistence Data Medical Evidence: Anal Fissures, Tears and Lacerations Anal Sphincter Tone Rectal Lacerations Other Injuries Lubricants Blood and Urine Analysis: Reason For Analysis Method of Sampling: Blood Urine Forensic Analysis Care of the Complainant: Medical Treatment Practical Pregnancy Sexually Transmitted Infections Psychological, Deborah Rogers and Mary Newton. Injury Interpretation: Introduction Describing Injuries: Nature of the Injury Size and Shape of the Injury Position of the Injury Aging Injuries Transient Lesions Types of Injury: Bruises Abrasions Lacerations Incisions Stab Wounds Firearm Injuries: Smooth Bore Weapon Rifled Weapons Shotgun Wounds Rifled Weapon Wounds Defense Injuries Torture, Jack Crane. Non-Accidental Injury in Children: Introduction: Definition Effects of Child Abuse Risk Factors For Abuse Extent of Abuse Non-Accidental Injury in Children: The Role of the Physician Assessing the Non-Accidentally Injured Child Pointers to the Diagnosis of NAI Types of Injuries in NAI: Soft Tissue Injuries: Bruising Bite Marks Other Soft Tissue Injuries Thermal Injury: Types of Thermal Injury Features of Thermal Injuries Suggestive of NAI Differential Diagnosis of Thermal Injuries Good Practice Tips Skeletal Injury: Dating Fractures Differential Diagnosis of Skeletal Injury Internal Injuri

Oral sex among female sex workers in Singapore has risen sharply from 27.1% in 1992 to 81.7% in 1997. A prospective cohort study was carried out on 724 female brothel-based sex workers who practised oral sex, to determine the risk of contracting pharyngeal gonorrhoea through inconsistent condom use. The prevalence of consistent condom use for oral sex was 70.4% compared to 96.8% for vaginal sex. One hundred and twenty-nine (17.8%) were lost to follow up because they quit prostitution. The other 595 sex workers were followed up for a maximum period of 6 months. Thirty-eight (5.2%) sex workers contracted pharyngeal gonorrhoea compared to 2.5% who contracted cervical gonorrhoea. Sex workers with inconsistent condom use for oral sex were 17.1 times (95% CI: 8.0-36.5) more likely than consistent condom users to develop pharyngeal gonorrhoea, after controlling for ethnic group, class and number of clients. STD control programmes for sex workers should place stress on consistent condom use for oral sex.This study examines the risks of pharyngeal gonorrhea due to inconsistent condom use among female sex workers in Singapore. A total of 724 brothel-based female sex workers who practiced oral sex were interviewed between December 1996 and June 1998. Data collected included sociodemographic characteristics, sexual behavior, and use of condom for oral sex. The results demonstrated a 70.4% prevalence of consistent condom use for oral sex as compared to 96.8% for vaginal sex. Of the 595 sex workers that were followed up for a maximum period of 6 months, 38 (5.2%) contracted pharyngeal gonorrhea, while 2.5% contracted cervical gonorrhea. It was revealed that sex workers with inconsistent condom use for oral sex were 17.1 times more likely to develop pharyngeal gonorrhea than consistent condom users. Since the risk of acquiring pharyngeal gonorrhea was significantly higher for inconsistent condom users, sexually transmitted disease control programs for sex workers should also emphasize the need for the consistent use of condoms with oral sex.

Objective: To document the sexual and contraceptive practices of women with HIV infection or who are at risk for infection. Design: Data on the baseline behaviors of 561 HIV-negative and 2040 HIV-positive women were collected as part of the Women‚s Interagency HIV Study (WIHS). WIHS is a multisite, longitudinal study following the natural history of HIV infection among women in the United States. Methods: Each participant contributed an interviewer administered, self-report interview including questions on sexual and contraceptive behavior. Results: Women with HIV were less likely to report heterosexual activity in the previous 6 months (65% HIV-positive, 76% HIV-negative). Among sexually active women, there were no differences in the proportion of those reporting vaginal (97% HIV-positive, 98% HIV-negative) or anal sex (12% HIV-positive, 10% HIV-negative), although women with HIV were less likely to report cunnilingus (41% HIV-positive, 70% HIV-negative) and fellatio (48% HIV-positive, 57% HIV-negative). Of women with HIV, 63% always used condoms during vaginal sex (versus 28% HIV-negative), with lower rates reported during other sexual activities. Crack, cocaine, or injecting drug use, reported by 27% of HIV-positive and 35% of HIV-negative women, was associated with inconsistent condom use, independent of serostatus. HIV-positive women who reported using condoms and another contraception method were less consistent condom users (57% consistent versus 67%). Conclusions: The prevalence of sexual risk behavior in this sample suggests that, although women with HIV exhibit lower levels of sexual risk behavior than uninfected women, many have not been successfully reached with regard to implementing safer behaviors. These findings have implications for more widespread and effective behavioral intervention efforts.

We investigated by means of vaginal plethysmography the extent to which the genital reactions of women with dyspareunia (N = 18) differed from those of women without dyspareunia (N = 16) during sexual arousal. In addition, we used questionnaires to investigate whether the genital reaction was correlated with the women's subjective experience of sexual arousal. In both groups, there was a clear increase in vaginal vasocongestion while they watched various erotic scenes compared with the situation at rest. While participants watched video fragments showing oral sex (cunnilingus and fellatio), the reactions were the same across the two groups. While participants watched video fragments showing coitus, there was a further increase in vaginal vasocongestion in the women without dyspareunia, but a decrease in vasocongestion in women with dyspareunia. The results of questionnaires assessing their perceived levels of sexual arousal while watching the video fragments showed that this reduction in genital response in the women with dyspareunia went unnoticed.

OBJECTIVES: To compare variables of sexual behaviour and incidence of genital infections among heterosexual men of different racial origins. DESIGN: A prospective cross sectional study of sexual behaviour reported by a standardised self administered questionnaire in new patients who presented for screening and diagnosis. SETTING: A genitourinary medicine clinic in west London. SUBJECTS: 1212 consecutive heterosexual men newly attending in 1993-4. MAIN OUTCOME MEASURES: Variables relating to sociodemographic status, sexual behaviour, condom use, sexually transmitted diseases, and other genital infections stratified by racial origin. RESULTS: There were 941 evaluable heterosexual men of whom the majority were white (79%) and 17% were black. The black men comprised more teenagers (11% cf 2%; p < 0.00001), were more likely to be unemployed (26% cf 12%; p < 0.00001), to have commenced intercourse much earlier (45% cf 22% before aged 16: p < 0.0001), and to have had intercourse with an African woman (14% cf 6%; p < 0.001). Both fellatio (64% cf 96%; p < 0.00001) and cunnilingus (40% cf 92%; p < 0.00001) were practised less frequently by the black men and so too was anal intercourse (11% cf 27%; p < 0.00001). Similar proportions from both groups were non-smokers (53% cf 57%), but a significantly higher proportion of the black men did not drink alcohol (13% cf 5%; p < 0.001). Gonorrhoea (15% cf 1%; p < 0.00001), chlamydial infection (17% cf 8%; p < 0.001), and non-gonococcal urethritis (37% cf 24%; p = 0.001) were diagnosed more frequently in the black men. These findings remained significant after logistic regression and are therefore independently associated with black race. However, there was no significant difference in numbers of sexual partners in the preceding year (median 2), nor in condom use with regular and non-regular partners. The Asian men had commenced intercourse later (mean 19.1 years) than both the black men (mean 15.9 years) and the white men (mean 17.3 years). CONCLUSIONS: Compared with white men, black men attending a genitourinary medicine clinic were much more likely to be unemployed, to have commenced intercourse earlier and to have urethral infection. They were much less likely to practice fellatio, cunnilingus, or anal intercourse. However, there was no difference between the two racial groups in respect of numbers of sexual partners and condom use.

Orogenital sex in the last decades has become a common sexual practice (fellatio and cunnilingus) between both heterosexual and homosexual individuals. Consequently, several sexually transmitted diseases (STDs) including bacterial infections, are a persistent problem in Europe and throughout the world, despite vigorous efforts in prevention and people education. The last two decades, HIV infection, revived the interest of the medical community and the people for the sexually transmitted diseases. Many of these bacterial infections present predominantly with characteristic oral signs and symptoms. As a result, it is imperative for the oral physician (stomatologist) to keep abreast of the latest updates in the behavior and to be aware of the whole spectrum of clinical manifestations of these diseases. Orogenital bacterial infections may be divided into two major categories: (i) Common including syphilis and gonorrhoea and (ii) Rare, including chlamydia trachomatis infection and tropical sexually transmitted infections (chancroid, donovanosis, lymphogranuloma venereum). Syphilis is the leader of sexually transmitted diseases and has been of great interest in the past and today and has played a central role in medicine for several decades. The oral lesions of syphilis (primary secondary and tertiary stages) have a broad spectrum of manifestations, which mimic a lot of other oral lesions. The recent incidence data, the oral manifestations, the laboratory tests and treatment of both categories of these diseases will be discussed, as the increased practice of oral sex has become a more important potential route of transmission for oral and genital bacterial pathogens. Stomatologists and Dentists, frequently evaluate oral mucosal manifestations and thus play an important role in the diagnosis and treatment of many of highly infectious sexually transmitted infections.

Some of the most colourful evidence for Roman sexual behaviour, such as Seneca’s charge of cunnilingus and ‘menophilia’ against Mamercus Scaurus, should not be regarded as factual. Seneca applies a longstanding stereotype, directly or indirectly inspired by the tactics of Scaurus’ prosecutors, who possibly exploited a medical treatment Scaurus used.