Dear Dr G, I know you are a urologist and tend to answer questions for men. However, I hope you can also help me to resolve some concerns I have about sex. I am 22 years old and started going out with my boyfriend for the last months. Things are going on really well between us, and we are a “bit physical”. Don’t get me wrong, we have not started having sexual relationship, however, we started having oral sex. My boyfriend is keen on oral sex, however, after the first time of giving oral sex, I am not sure I really enjoyed it as much as him. The problem is, I really think the men’s private parts are not always clean and I worry about hygiene issues. Besides, I also worry about sexually transmitted infections! I tried to talk to my boyfriend about this. He said oral sex is not really sex, and there is no risk of sexually transmitted infection. I am so sorry to put Dr G on the spot, but can you clarify whether oral sex is real sex? Is there any way of catching sexually transmitted infections from oral sex? Besides, is there any protection available? Regards Lady fan Oral sex is technically a form of sexual activity. This involves the stimulation of the genitalia using the mouth, namely the lips, tongue, throat or teeth. The oral stimulation of the other parts of the body is technically not considered oral sex. The act of oral sex can be provided for both genders. The oral sex performed on a woman is primarily termed cunnilingus, while a man receiving oral sex is called fellatio. The other form of oral sex can also be considered, when the anus of the person is stimulated orally, this is a less common form of oral sex called anilingus. Oral sex is often regarded as taboo in many cultures, especially in the form of cunnilingus or anilingus. Despite being such an embarrassing topic of sexual health, the national statistics show that most Americans have some experience with oral sex in the early teens. Up to 90% of the adults aged 25-44 have had oral sex with someone of the opposite sex, according to a CDC survey. It was also revealed that oral sex is commonly practised by male-female and same-gender couples of various ages, and males are more likely than females to have received oral sex. Equal proportions of men and women have given oral sex, were also noted in the same study. In another study, the teens in the US were noted to have oral sex before they started sexual intercourse, as they perceive such practice to be less risky compared to “real” sex. The study demonstrated that most teens thought engaging in oral sex is considered as having less social, emotional and health risks. However, among sexually active youths, around 2% admitted to have caught sexually transmitted infections when only engaging in oral sex, compared with 5% in vaginal sex, and 13% of those who had both. So, how safe is oral sex? Indeed, there is absolutely no risk in getting pregnant with oral sex, but the risk of catching or passing a disease during oral sex is not uncommon. The commonest form of pathogens that can be passed on through oral sex include herpes, gonorrhea and syphilis. Other less common diseases are chlamydia, genital warts, pubic lice, hepatitis B and C, and even HIV. The risk is generally higher if you give rather than receiving oral sex because the risk of being exposed to genital fluids is higher. The risks increases if the person performing oral sex has cuts, ulcers or sores in the mouth during the act. The use of barrier protection can reduce the risk of getting sexually transmitted infections. For oral sex on a man, the use of condom will reduce the risk of transmission. And as for women, the use of a dam, which is a small thin square of latex that acts as barrier between the vagina or anus can help to prevent the spread of pathogens. Some clinicians reckon people don’t use protection for oral sex probably because they are unaware of the risk of disease transmission. I hate to point out the obvious, who wants to have the taste of rubber in their mouth during the heightened sense of climax? Despite the lack of interest in using a condom during oral sex, one form of protection worth noting is the prevention of throat cancer transmitted by oral sex. In reality, it is not the oral sex that causes cancer, but the transmission of Human Papilloma Virus (HPV) from person to person during oral sexual contacts (As made well known to all of us by Michael Douglas). A study published in the New England Journal of Medicine also highlighted a greater risk of orophryngeal cancer in people that had oral sex with at least six partners. The DNA of type 16 was often found in the cancers of people who had multiple sex partners. As the vaccine to prevent the contraction of HPV 16 is now widely available, it is essential to get the protection, before engaging in any oral sexual contact. So, having addressed all the issues of how safe is oral sex, the next question would be: “Is oral sex ‘real’ sex?” In many cultures, oral sex is commonly used as a means of preserving virginity. This is often referred as technical virginity compared with penetrative intercourse. Of course, before the Clinton years, oral sex is often perceived edgy and taboo. Is defining oral sex as real sex in the 21st century still relevant? When Dr G is put on the spot on this issue, his response is that it might be a safer form of sex, but still “not completely” safe. Is “oral sex ‘real’ sex?” Dr G’s response is – get to know your partner well before engaging in any form of intimacy, as the definition of “real sex” or “not real sex” is unreal! 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