The truth about oral sex, from cancer risk to what teens say about it.
By Martin Downs, MPH
Reviewed by Marina Katz, MD
People who came of age before the Clinton years can remember when oral sex still seemed edgy, even taboo. Now, we're as likely to hear about oral sex on the evening news as on late-night TV.
National statistics show that most Americans have some experience with oral sex, beginning in the early teen years. Almost half of teens and almost 90% of adults aged 25-44 have ever had oral sex with someone of the opposite sex, according to a CDC survey done between 2006 and 2008.
Oral sex can be an enjoyable, healthy part of an adult relationship. But there are some things that many people don't know about oral sex. Here are four facts that might surprise you.
1. Oral sex is linked to throat cancer.
It's not oral sex, per se, that causes cancer, but the human papillomavirus (HPV), which can be passed from person to person during sex, including oral sex.
Researchers have found that some cancers of the oropharynx (the middle of the throat) and tonsils are probably caused by a certain type of human papillomavirus (HPV). HPV is common, but it doesn't always cause cancer. If you aren't exposed to HPV during oral sex, you're not at risk for cancer.
Brawley says that hints of a link between HPV and oropharyngeal cancer came in the late 1980s and early '90s. Researchers noticed an increase in this kind of cancer among people who hadn't been very prone to it before.
It began to affect increasing numbers of people around the age of 40 that didn't smoke or drink, whereas in prior decades these cancers were usually found in older people that smoked cigarettes and heavily drank hard liquor.
In the early 2000s, scientists were able to use advanced DNA testing to find HPV 16 in many of these newer cancers.
Brawley determined that sexual activity must be involved.
A study published in The New England Journal of Medicine in 2007 showed a greater risk for oropharyngeal cancer in people that had had oral sex with at least six different partners. The DNA signature of HPV type 16 was often found more often in the cancers of people who had multiple oral sex partners.
It's still unclear how many people get HPV throat infections by oral sex, or how many of them get oropharyngeal cancer, Brawley reports.
Both men and women can have an HPV infection in the throat. "It doesn't discriminate by gender," Brawley says.
"The population that I thought would be least likely to get it was the first population to have this problem," he says. That population was heterosexual men aged 40-50.
Doctors know, however, that oropharyngeal cancers caused by HPV are easier to treat than those caused by factors like smoking and drinking.
Brawley says the best prevention method is still unclear, but "in terms of public awareness, this information certainly should be available to people," he says.
Expanding the use of the HPV vaccine could be one approach, but Brawley says, "I'm not sure that we have studies enough to make a blanket assertion that this is a reason to vaccinate boys for HPV." The FDA has approved the HPV vaccine Gardasil for males aged 9-26 -- but only to help prevent genital warts in those boys and young men, not as a way to curb HPV infection in their partners. The CDC's Advisory Committee on Immunization Practices allows but doesn't require boys as young as 9 to get Gardasil.
2. Oral sex enhances some adult relationships, strains others.
Among adults, oral sex causes stress for some couples and enhances intimacy for others, says sex therapist Louanne Cole Weston, PhD, of Fair Oaks, Calif. She says stress about oral sex often has to do with one partner's concerns about hygiene.
"One person will not want to receive it because he or she worries about the partner's reaction," Weston says.
Some people may also be anxious about their performance -- doing it well enough to please a partner -- or about responding appropriately to receiving it. "Some people can't just let go and receive," Weston says.
Sexual power dynamics may be part of it, too.
"Some people resist doing it because they feel a bit subjugated," Weston says. Her advice for those people: "They have a very important body part between their teeth; and after all, who is in charge in a position like that?"
Other people, Weston says, experience oral sex as a "relationship strengthener" and "a very intimate connection" shared with a partner. "It's being able to look at the partner and see them going into really very personal space," Weston says.
3. Unprotected oral sex is common, but has risks.
"Oral sex is not safe sex," says Terri Warren, RN, owner of Westover Heights Clinic in Portland, Ore., a private clinic specializing in STDs. "It's safer sex, but it's definitely not safe sex."
The risks depend on a lot of different things, including how many sexual partners you have, your gender, and what particular oral sex acts you engage in.
Using barrier protection can reduce the risk of getting an STD. A barrier can be a condom covering the penis, or a plastic or latex "dental dam" placed over the vulva or anus. Instead of a prepackaged dental dam, a condom cut open to make a sheet is also an acceptable barrier.
But most people don't use protection for oral sex. That's common wisdom, and it's also shown by large-scale surveys of sexually active teens and adults.
That's probably because many people don't know that STDs can be spread orally. Or if they do, they don't see the health risks as being very serious, Warren says.
The risks of getting an STD from unprotected oral sex are typically much lower than the risks posed by having unprotected vaginal or anal sex, Warren says.
Warren's advice about using barrier protection for oral sex depends on whom she's talking to. Typically, performing oral sex on a male partner without a condom is riskier than other forms of oral sex, she says.
For example, Warren says she might stress the importance of condom use for a man having oral sex with multiple male partners.
"If a male is giving oral sex to a woman, I consider that to be a low-risk exposure," Warren says. But if a woman's regular partner has oral herpes, "that's a whole different discussion," she says.
4. Oral sex is common among teens.
Many U.S. teens have oral sex before they have vaginal sex. And they don't view it as very risky, says Bonnie Halpern-Felsher, PhD, a pediatrics professor at the University of California, San Francisco.
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Compared with vaginal sex, "They really don't consider it as big of a deal," Halpern-Felsher tells WebMD. Past surveys Halpern-Felsher conducted showed that most teens thought that engaging in oral sex would not put them at risk for social, emotional, or health problems. Other surveys she has performed showed teens who said they only had oral sex were less likely than those who had vaginal sex or vaginal and oral sex to report STDs.
Still, there were STDs among all three groups of sexually active teens. Just under 2% of teens who said they'd only had oral sex said they caught an STI, compared with about 5% of those who had vaginal sex only, and 13% of those who had vaginal and oral sex.
The oral sex-only teens were also less likely than other sexually active teens to report getting into trouble with parents, experiencing negative feelings, or having a worsening relationship with a partner because of their sexual activity.
But there was a gender gap in how teens felt about oral sex.
Males were more likely than females to claim social and emotional benefits. Females were more likely to report feeling used or guilty, or that oral sex had hurt a relationship.
In another survey, 425 ninth-graders from the same group were asked open-ended questions about why they thought that people their age would have oral sex.
The idea that it's less risky than vaginal sex was their No. 5 reason. Here are their top four reasons : 1) seeking pleasure, 2) improving relationships, 3) gaining popularity, and 4) curiosity.
That list differed between males and females. Pleasure was the No. 1 reason cited by males; females said their main motivation was to improve a relationship.
Otis Brawley, MD, chief medical officer, American Cancer Society.
Terri Warren, RN, ANP, Westover Heights Clinic, Portland, Ore.
Bonnie Halpern-Felsher, PhD, professor of pediatrics, University of California, San Francisco.
Louanne Cole Weston, PhD, licensed marriage and family therapist , board-certified sex therapist, Fair Oaks, Calif.
National Center for Health Statistics, National Survey of Family Growth, 2002.
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Halpern-Felsher, B. Pediatrics, April 2005; vol 115: pp 845-851.
Brady, S. Pediatrics, February 2007; vol 119: pp 229-236.
Cornell, J. Journal of Adolescent Health, March 2006; vol 38: pp 299-301.
Reviewed on September 05, 2011
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