Since the “Sexual Revolution” of the 1960s, oral sex has become a more common sexual behavior among people of all ages.¹ It has often been assumed that men have a greater interest in oral sex than women. It is also commonly assumed that when oral sex occurs, it is much more likely that a female is performing oral sex on a male than it is a male performing oral sex on a female.

According to a study about sexual behavior in the United States, however, there is little to no gender difference in the prevalence of oral sex, indicating that males and females experience oral sex at about the same rate.² The U.S. sexual health survey also examined specific oral sex behavior and found that there was little difference in the percentages of men and women reporting that they had given and received heterosexual oral sex.² This notion counters the stigmas and stereotypes surrounding oral sex, in that women do not actually give oral sex more than they receive and men are more open to cunnilingus. For example, among women aged 18-19, 58.5% reported that they had performed oral sex on a male partner in the previous year and 58.0% reported that they had received it from a male partner during the same time period.

With this increase in the rate of oral sex, the rate of sexually transmitted infections (STIs) among adolescents is increasing at an unprecedented rate. Oral sex was once considered taboo, an act reserved for homosexuals or prostitution. This mindset changed as average couples began adopting oral sex. Studies revealed it was more common in previous decades. Oral sex has a high risk STI-transmission because of direct transmission of bodily fluids into and on the mouth. Currently, over three million American teenagers become infected with one or more STIs each year, including both bacterial (e.g. gonorrhea, chlamydia) and viral infections (e.g. herpes, HIV).⁴ Non-penile/vaginal sexual behaviors also pose a risk for STIs among adolescents. For instance, public attention has focused on the surprisingly high percentage of high school adolescents (grades 9 through 12) who report engagement in oral sex. Data suggest that approximately 33%–59% of high school teens and, more specifically, 7%– 24% of adolescent virgins report that they have either given or received oral sex.⁵ The focus of this article is to address adolescents’ potential for contracting an STI from engaging in oral sex and the possible psychological factors that may influence adolescents’ decision to engage in this type of behavior.

Oral sex does not have to be a risky behavior if proper protection is used. Using flavored condoms is just one example of how to have safe oral sex. Nonetheless, the risk of acquiring an STI through engagement in oral sex is substantially less than other sexual behaviors (e.g. vaginal or anal intercourse). Oral sex is a viable mode of transmission for several bacterial and viral infections, including gonorrhea, herpes and chlamydia. Some reports also have documented cases of HIV infection occurring during oral-genital contact.⁶ The rise in oral sex could be attributed to adolescents who wish to avoid the risks and or psychological commitments associated with penile/vaginal/anal sexual behaviors.

Several theoretical models suggest that social factors may influence decisions to engage in health risk behaviors. For instance, the theory of reasoned action and the information–motivation– behavioral skills models emphasize the role of social norms in guiding teens’ intentions and motivations regarding health behaviors.⁷ In addition to familial, community and media influences, an adolescent’s perception of societal normality may also be guided by his or her friends’ behavior.⁷ Friends are the most available and relevant reference group and the most likely source of information for teens on the practices, norms, and risks associated with sexual behavior. Adolescents are also likely to evaluate the risks associated with specific sexual behaviors through social comparisons with close friends. Past research has demonstrated that teens’ beliefs regarding their friends’ engagement in risky sexual behavior may be associated with their own reported engagement in risk behavior.⁸ Moreover, past work suggests that preadolescent girls with friends who engaged in sexual intercourse before high school are more likely to initiate sexual intercourse behavior in early adolescence than girls with virginal friends.⁵

Overall, a significant majority of adolescents reported that their best friends’ oral sex behavior was similar to their own oral sex behavior. In a study of 86 adolescents who reported engagement in oral sex, 56.5% reported that their best friend had also engaged in oral sex in the past year.⁹ Of the 126 teens that did not engage in oral sex activity, 82.5% reported that their best friend also did not engage in oral sexual activity.⁹ In this study, adolescents reported that they are significantly more likely to engage in oral sex than in intercourse and engage in oral sex with significantly more partners than for intercourse. Adolescents also reported that they are unlikely to use STI protection during oral sex.⁹

Adolescents’ behavior may place them at maximum risk for genital-oral transmission of STIs. Strictly oral transmission is through kissing or deep kissing. Initial steps for prevention would be increased education for adolescents concerning the reduced, but still significant risks associated with oral sex. We do not endorse these behaviors as dangerous; rather, we inform about the necessity of protection to ensure the most rewarding sexual experiences possible. Just because an act is popular does not mean it is safe without precautionary measures. Please make informed decisions about engagement in and use of protection during oral sex.

References:

1.     Hyde, J.S., Delameter, J.D. & Byers, E.S. (2010). Understanding Human Sexuality. Toronto, ON: McGraw-Hill Ryerson.

2.     Herbenick, D. et al. (2010). Sexual behavior in the United States: Results from a national probability sample of men and women ages 14-94. Journal of Sexual Medicine, 7(suppl 5), 255-265.

3.     Catania, J. A., Kegeles, S. M., & Coates, T. J. (1990). Towards an understanding of risk behavior: An AIDS risk reduction model (ARRM). Health Education Quarterly, 17, 53 –72. UC-eLinksMedlineWeb of Science

4.     Centers for Disease Control and Prevention. (2000). Sexually transmitted disease surveillance 1999. Atlanta: Department of Health and Human Services.

5.     Billy, J. O. G., & Udry, J. R. (1985). The influence of male and female best friends on adolescent sexual behavior. Adolescence, 20, 21–32. UC-eLinksMedlineWeb of Science

6.     Keet, I. P., Albrecht van Lent, N., Sandfort, T. G., Coutinho, R. A., & van Griesven, G. J. (1992). Orogenital sex and the transmission of HIV among homosexual men. AIDS, 6, 223 –226. UC-eLinksMedlineWeb of Science

7.     Fishbein, M., & Azjen, I. (1975). Belief, attitude, intention, and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley.

8.     Walter, H. J., Vaughan, R. D., Gladis, M. M., Ragin, D. F., Kasen, S. & Cohall, A. T. (1992). Factors associated with AIDS risk behaviors among high school students in an AIDS epicenter. American Journal of Public Health, 82, 528 –532.

9.     Breakwell, G. M., & Fife-Schaw, C. (1992). Sexual activities and preferences in a United States sample of 16- to 20-year olds. Archives of Sexual Behavior, 21, 271–293. UC-eLinksCrossRefMedlineWeb of Science

Last Updated 12 January 2014.