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Concept: Foreplay


Male genital satisfaction is an important aspect of psychosocial and sexual health. The Index of Male Genital Image (IMGI) is a new scale that measures perceptions of male genitalia. We aim to characterize genital satisfaction using the IMGI and correlate dissatisfaction with sexual activity. We conducted a nationally representative survey of non-institutionalized adults aged 18-65 years residing in the U.S. In total, 4198 men completed the survey and 3996 (95.2 %) completed the IMGI. Men reported highest satisfaction with the shape of their glans (64 %), lowest satisfaction with the length of their flaccid penis size (27 %), and neutrality with the scent of their genitals (44 %). No demographic characteristics (age, race, sexual orientation, education, location, and income) were significantly associated with genital dissatisfaction. Men who were dissatisfied with their genitals were less likely to report being sexually active (73.5 %) than those who were satisfied (86.3 %). Penetrative vaginal sex (85.2 vs. 89.5 %) and receptive oral intercourse (61.0 vs. 66.2 %) were reported less by dissatisfied men. Overall, most U.S. men were satisfied with their genitals; however, a subset (14 %) report low genital satisfaction, which included men of all ages, races, and socioeconomic groups. Low genital satisfaction is associated with a decrease in sexual activity. These results provide clinicians and health educators a baseline of genital satisfaction to provide education and reassurance.

Concepts: Sexual intercourse, Oral sex, Human sexual behavior, Human sexuality, Penis, Foreplay, Sex organ, Human penis size


Passion and sexual satisfaction typically diminish in longer-term relationships, but this decline is not inevitable. We identified the attitudes and behaviors that most strongly differentiated sexually satisfied from dissatisfied men and women who had been together for at least three years (N = 38,747). Data were collected in 2006 from cohabiting and married men (M) and women (W) via an online survey on a major national U.S. news Web site. The vast majority of these participants reported being satisfied with their sex lives during their first six months together (83% W; 83% M). Satisfaction with their current sex lives was more variable, with approximately half of participants reporting overall satisfaction (55% W; 43% M) and the rest feeling neutral (18% W; 16% M) or dissatisfied (27% W; 41% M). More than one in three respondents (38% W; 32% M) claimed their sex lives were as passionate now as in the beginning. Sexual satisfaction and maintenance of passion were higher among people who had sex most frequently, received more oral sex, had more consistent orgasms, and incorporated more variety of sexual acts, mood setting, and sexual communication. We discuss implications of these findings for research and for helping people revitalize their sex lives.

Concepts: HIV, Sexual intercourse, Oral sex, Human sexual behavior, Human sexuality, Orgasm, Foreplay, Orgasm control


OBJECTIVES:This study aimed to examine the prevalence of sexting behaviors (sexually explicit messages and/or pictures) among an at-risk sample of early adolescents as well as the associations between sexting behaviors and sexual behaviors, risk-related cognitions, and emotional regulation skills. It also aimed to determine whether differences in risk were associated with text-based versus photo-based sexts.METHODS:Seventh-grade adolescents participating in a sexual risk prevention trial for at-risk early adolescents completed a computer-based survey at baseline regarding sexting behavior (having sent sexually explicit messages and/or pictures), sexual activities, intentions to have sex, perceived approval of sexual activity, and emotional regulation skills.RESULTS:Twenty-two percent of the sample reported having sexted in the past 6 months; sexual messages were endorsed by 17% (n = 71), sexual messages and photos by 5% (n = 21). Pictures were endorsed significantly more often by females (χ(2)[2] = 7.33, P = .03) and Latinos (χ(2)[2] = 7.27, P = .03). Sexting of any kind was associated with higher rates of engaging in a variety of sexual behaviors, and sending photos was associated with higher rates of sexual activity than sending text messages only. This was true for a range of behaviors from touching genitals over clothes (odds ratio [OR] = 1.98, P = .03) to oral sex (OR = 2.66, P < .01) to vaginal sex (OR = 2.23, P < .01).CONCLUSIONS:Sexting behavior (both photo and text messages) was not uncommon among middle school youth and co-occurred with sexual behavior. These data suggest that phone behaviors, even flirtatious messages, may be an indicator of risk. Clinicians, parents, and health programs should discuss sexting with early adolescents.

Concepts: HIV, Sexual intercourse, Oral sex, Human sexual behavior, Human sexuality, Human behavior, Foreplay


A case is described of a 40 year old woman with persistent spontaneous orgasms after use of Cannabis and five hour hard pounding sexual activity. She presented with severe anxiety in particular to suffer from Restless Genital Syndrome (ReGS). However, she did not fulfill to any of the five criteria of ReGS. It was concluded that her spontaneous orgasms were the result of the use of Cannabis combined with long duration of previous sexual activity. This is not only important for physicians but alsof for highly exposed subjects like those active in the sex industry.

Concepts: Sexual intercourse, Uterus, Human sexual behavior, Human sexuality, Orgasm, Penis, Foreplay, Sexual arousal


A 29-year-old male patient presented to eye emergency clinic after noticing a left paracentral scotoma on waking. On direct questioning the patient revealed an episode of vigorous sexual intercourse the preceding evening. During orgasm the valsalva manoeuvre can produce a sudden increase in retinal venous pressure resulting in vessel rupture and haemorrhagic retinopathy. Valsalva retinopathy is managed conservatively and the patient’s symptoms resolved spontaneously without intervention. This case report highlights the importance of focused history taking of patients which can thereby obviate the need for further investigations. This case also emphasises the importance of considering sexual activity as a cause of stress-induced pathology.

Concepts: Sexual intercourse, Blood, Patient, Hospital, Human sexual behavior, Human sexuality, Orgasm, Foreplay


Women who have sex with women (WSW) are more likely to report experiencing an orgasm during partnered sex, compared to women who have sex with men (WSM). We investigated whether this difference can be partially accounted for by phallocentric imperatives-gendered sexual scripts that prioritize men’s sexual experience. For example, these imperatives emphasize vaginal-penile intercourse (i.e., the coital imperative) and men’s physical pleasure (i.e., the male orgasm imperative). We reasoned that a larger variety of sexual behaviors indicates less adherence to the coital imperative and that more self-oriented orgasm goals for women indicate less adherence to the male orgasm imperative. Consistent with previous work, we expected WSW to report higher rates of orgasm than WSM when taking frequency of sex into account. We also hypothesized that this difference in orgasm rates would dissipate when controlling for variety of sexual behavior and women’s self-oriented orgasm goals. In a sample of 1988 WSM and 308 WSW, we found that WSW were 1.33 times (p < .001) more likely to report experiencing an orgasm than WSM, controlling for frequency of sex. This incidence rate ratio was reduced to 1.16 (p < .001) after taking into account variety of sexual behavior and self-oriented orgasm goals. Our findings indicate that certain sexual scripts (e.g., phallocentric imperatives) help explain the orgasm discrepancy between WSW and WSM. We discuss masturbation as another male-centered practice that may be relevant to this gap, as well as implications for intervention and future research.

Concepts: Sexual intercourse, Human sexual behavior, Human sexuality, Orgasm, Foreplay, Sexual arousal, Masturbation, Human sexual response cycle


Which sexual activities result in the most frequent and most satisfying orgasms for men and women in same- and mixed-sex relationships? The current study utilized a convenience sample of 806 participants who completed an online survey concerning the types of sexual activities through which they experience orgasms. Participants indicated how frequently they reached orgasm, how satisfied they were from orgasms resulting from 14 sexual activities, and whether they desired a frequency change for each sexual activity. We present the overall levels of satisfaction, frequency, and desired frequency change for the whole sample and also compare responses across four groups of participants: men and women in same-sex relationships and men and women in mixed-sex relationships. While all participants reported engaging in a wide variety of activities that either could, or often did, lead to the experience of orgasm, there were differences in the levels of satisfaction derived from different types of orgasms for different types of participants, who also engaged in such activities with varying degrees of frequency. We discuss group differences within the context of sexual scripts for same- and mixed-sex couples and question the potential explanations for gender differences in the ability to experience orgasm during partnered sexual activity.

Concepts: Sexual intercourse, Gender, Gender role, Human sexual behavior, Human sexuality, Gender identity, Orgasm, Foreplay


Touching is a powerful means for eliciting sexual arousal. Here, we establish the topographical organization of bodily regions triggering sexual arousal in humans. A total of 704 participants were shown images of same and opposite sex bodies and asked to color the bodily regions whose touching they or members of the opposite sex would experience as sexually arousing while masturbating or having sex with a partner. Resulting erogenous zone maps (EZMs) revealed that the whole body was sensitive to sexual touching, with erogenous hotspots consisting of genitals, breasts, and anus. The EZM area was larger while having sex with a partner versus while masturbating, and was also dependent on sexual desire and heterosexual and homosexual interest levels. We conclude that tactile stimulation of practically all bodily regions may trigger sexual arousal. Extension of the erogenous zones while having sex with a partner may reflect the role of touching in maintenance of reproductive pair bonds.

Concepts: Sexual intercourse, Human sexuality, Clitoris, Orgasm, Penis, Foreplay, Sexual arousal, Erogenous zone


Sexual assault continues to be a salient health concern, especially among college women. Because assault is often defined in terms of consent, prevention efforts hinge on promoting the definition and the obtainment of consent as a mechanism to reduce assault. Despite the focus on consent promotion, research specifically examining consent in general and among college students specifically is limited. College students (n = 185) were recruited to participate in an open-ended survey in which they were asked to report how they indicated consent and interpreted their partners' consent to engage in a range of sexual behaviors. Content analysis was utilized to qualitatively analyze responses. In the current study, data were assessed for emerging themes across all items. In examining participants' responses, four distinct themes emerged: (a) endorsement of the traditional sexual script; (b) women are responsible for performing oral sex; © men’s consent to sex can be aggressive; and (d) men utilize deception to obtain consent to sex. Findings suggest that men are conceptualized as sexual initiators and women as sexual gatekeepers, and that men’s sexual pleasure is primary whereas women’s experience of pleasure is secondary. Findings articulate the need for more pointed research aimed at assessing sexual consent among college students.

Concepts: Sexual intercourse, Oral sex, Human sexual behavior, Human sexuality, Rape, Foreplay, Sexual assault, Age of consent


Introduction.  Exogenous lubricant use in the United States is common among women; however, there is little empirical research describing women’s perceptions of lubricants, lubricant use, and vaginal wetness or dryness during penile-vaginal intercourse or other sexual behaviors. Aims.  To assess women’s perceptions about lubricant use, women’s perceptions about vaginal wetness during sexual activities, lubricant purchasing and application patterns, and the relationship of age to women’s perceptions of lubricants and vaginal wetness. Methods.  Cross-sectional baseline data from an online daily diary study of 2,451 women enrolled in a study of lubricant use were analyzed. Main Outcome Measures.  Demographic items, women’s lubricant purchasing patterns, lubrication use, perceptions about lubrication, and perceptions about vaginal wetness. Results.  Overall, women felt positively about lubricant and lubricant use, preferred sex to feel more wet, felt that they were more easily orgasmic when sex was more wet, and thought their partner preferred sex to feel more wet than dry. Perceptions varied by age group with women in their forties reporting more positive perceptions of lubricants than women under the age of 30. Conclusions.  Findings suggest that women generally feel positively about lubricants and lubricant use and prefer vaginal-penile intercourse to feel more wet. Such insights into women’s perceptions of lubricants and lubricant use can be helpful to medical and other health professionals as well as sexual health educators, who routinely make recommendations to women about ways to incorporate products, such as lubricants, into their sexual activities. Jozkowski KN, Herbenick D, Schick V, Reece M, Sanders SA, and Fortenberry JD. Women’s perceptions about lubricant use and vaginal wetness during sexual activities. J Sex Med **;**:**-**.

Concepts: Sexual intercourse, Liquid, Human sexual behavior, Human sexuality, Human behavior, Orgasm, Foreplay, Lubricants