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Sanders SA, Reinisch JM. Would You Say You "Had Sex" If . . . ? JAMA. 1999;281(3):275–277. doi:10.1001/jama.281.3.275
Context The current public debate regarding whether oral sex
constitutes having "had sex" or sexual relations has reflected a
lack of empirical data on how Americans as a population define these
Objective To determine which interactions individuals would
consider as having "had sex."
Methods A question was included in a survey conducted in 1991 that
explored sexual behaviors and attitudes among a random stratified
sample of 599 students representative of the undergraduate population
of a state university in the Midwest.
Participants The participants originated from 29 states, including
all 4 US Census Bureau geographic regions. Approximately 79%
classified themselves as politically moderate to conservative.
Main Outcome Measure Percentage of respondents who believed the
interaction described constituted having "had sex."
Results Individual attitudes varied regarding behaviors defined as
having "had sex": 59% (95% confidence interval, 54%-63%) of
respondents indicated that oral-genital contact did not constitute
having "had sex" with a partner. Nineteen percent responded
similarly regarding penile-anal intercourse.
Conclusions The findings support the view that Americans hold
widely divergent opinions about what behaviors do and do not constitute
having "had sex."
degree to which individuals vary with respect to the behavioral
criteria involved in labeling an interaction as having "had sex"
has implications for both clinical and research purposes. Recent public
discourse regarding whether oral-genital contact constitutes having
"had sex" highlights the importance of explicit criteria in
contrast with implicit assumptions in this area. Unfortunately, a
review of the literature demonstrates that empirical exploration of
what is included in definitions of having "had sex" for the general
public in the United States remains scant. Social and legal definitions
of "sex," "sex act," "having sex with," "sexual
relations," and various crimes related to having "had sex,"
including adultery, rape, and statutory rape, vary depending on the
source but often refer to sexual intercourse, which, in turn, is often
defined as "coitus" or "copulation."1-5 Not
surprisingly, engaging in behaviors other than penile-vaginal
intercourse is a strategy used by some to preserve "technical
virginity."6-11 In keeping with such views, a 1996
convenience sample of college students found that almost 3 out of 4
students reported that they would not include in a list of their sexual
partners those with whom they only had oral sex.6 In
concert with that perspective, when asked, "Is oral sex ‘real'
sex?" only 52% of men and 46% of women said yes. However, this
suggests that for some, engaging in an act they define as "sex"
does not necessitate defining the other person as a "sexual
partner" and, hence, does not inevitably lead to labeling the
interaction as a sexual relationship.
The current public debate regarding whether oral sex constitutes
having "had sex" or sexual relations has suffered from a lack of
empirical data on how Americans as a population define these
terms.12,13 The data reported here were originally
collected in 1991 for their relevance to sexual history information
gathering and to specifically examine the need for behavioral
specificity to avoid possible confusion.14 These findings
also serve as an indication of attitudes regarding definitions of
having "had sex" among college students assessed prior to current
media publicity about this issue. The respondents today range in age
from late 20s to early 30s.
The study was approved by the university's institutional review board
human subjects committee. The data were collected in 1991 as part of a
survey containing 102 items addressing the prevalence and
interrelationships among behaviors associated with sexually transmitted
disease risk from a randomly selected, stratified undergraduate sample.
Participants were students at 1 of the largest Midwest state
universities, originating from 29 states (10 in the Midwest, 11 in the
South, 5 in the Northeast, and 3 in the West). The majority of
participants were from the Midwest. Potential participants were first
contacted by a letter informing them that they had been
chosen at random, explaining that The Kinsey
Institute for Research in Sex, Gender, and Reproduction Studies was
conducting a large survey of college student sexual behavior, and
describing the procedures for data collection and insurance of
confidentiality. Letters were followed by telephone contact to enlist
participation. Of the 1029 students contacted who were eligible and
potentially available, 599 undergraduates (58%) met the requirements
of completing the questionnaire in 13 supervised group sessions during
the 36-day study period and matched the racial demographics of the
university population. Those who did not participate either declined
because of lack of interest (23%) or did not show up for their
scheduled appointments (19%). Mean (SD) age was 20.7 (3.1) years, with
96% of the sample falling between ages 18 and 25 years. The sample was
59% female. Matched to university demographics, 92% were white, 4%
were black, and 4% identified themselves as a race/ethnicity other
than black or white. Ninety-six percent identified themselves as
heterosexual. When queried about their political position, 78.5%
classified themselves as moderate to conservative. Although 42% were
not registered to vote, there were more registered Republicans (32%)
than Democrats (19%), while 7% identified themselves as independent.
Additional details regarding the methods, sample demographics, and
behavioral data are presented elsewhere.15
The behaviors relating to having "had sex" were arranged in random
order to prevent the conveyance of a preconceived hierarchy. For each
behavior, valid percentages (including only those who answered yes or
no) and 95% confidence intervals (CIs) were determined for women, men,
and the overall sample. The item read, "Would you say you ‘had sex'
with someone if the most intimate behavior you engaged in
was . . . (mark yes or no for each behavior):
(a) a person had oral (mouth) contact with your breasts or nipples?
(b) you touched, fondled, or manually stimulated a person's genitals?
(c) you had oral (mouth) contact with a person's breasts or nipples?
(d) penile-vaginal intercourse (penis in vagina)?
(e) you touched, fondled, or manually stimulated a person's breasts
(f) a person had oral (mouth) contact with your genitals?
(g) you had oral (mouth) contact with a person's genitals?
(h) deep kissing (French or tongue kissing)?
(i) penile-anal intercourse [penis in anus (rectum)]?
(j) a person touched, fondled, or manually stimulated your breasts or
(k) a person touched, fondled, or manually stimulated your
Results are presented with 95% CIs and χ2 analyses
corrected for continuity were used for specific group comparisons.
As can be seen in the Table 1, almost
everyone agreed that penile-vaginal intercourse would qualify as having
"had sex." Approaching this level of common perspective and yet
importantly different is the fact that while 81% of participants
counted penile-anal intercourse as having "had sex," 19% did not.
In contrast, few individuals considered deep kissing (nearly 2%) or
breast contact (nearly 3%) as having "had sex" with a partner.
Answers to the breast contact items (a, c, e, and j) did not vary
substantially regardless of the directionality of behaviors or whether
contact was manual or oral. Approximately 14% to 15% indicated that
manual stimulation of the genitals (either given or received) would
constitute having "had sex." Only 40% indicated that they would
say they had "had sex" if oral-genital contact was the most
intimate behavior in which they engaged (60% would not). For the
behaviors less frequently included as having "had sex," men were
slightly more likely to incorporate them into the "had sex"
Seventy-four percent (95% CI, 69%-79%) of women and 80% (95%
CI, 74%-85%) of men had penile-vaginal intercourse experience.
Eighty-two percent (95% CI, 78%-87%) of women and 84% (95% CI,
79%-89%) of men had oral-genital experience. Responses to the "had
sex" question did not differ in general based on these experiences
with the following exception: of those who had experienced (1) both
oral-genital contact and penile-vaginal intercourse, (2) neither of
these behaviors, or (3) only penile-vaginal intercourse, 59% said that
oral-genital contact did not constitute having "had sex"
(95% CI, 54%-63%). In comparison, those whose most intimate sexual
experience was limited to oral-genital contact (8%; 95% CI, 6%-11%)
were significantly even more likely (75%; 95% CI, 62%-87%;
P=.04) to rate this form of contact as
not meeting their criteria for having "had sex."
These data make it clear that general agreement regarding what
constitutes having "had sex" and how sexual partners are counted
cannot be taken for granted. Among the behaviors assessed, oral-genital
contact had the most ambivalent status. Overall, 60% reported that
they would not say they "had sex" with someone if the most intimate
behavior engaged in was oral-genital contact. Additionally, we found
evidence of belief in "technical virginity." Compared with others,
those who had experienced oral-genital contact but had never engaged in
penile-vaginal intercourse were less likely to consider oral-genital
contact as having "had sex." These findings are consistent with
other reports indicating that oral sex is not consistently defined as
having "had sex"5-12 and seem relevant to the issue of
"technical fidelity" as well.
One out of 5 indicated they would not count penile-anal
intercourse as having "had sex." This finding has implications for
sexual history taking and prevention education, given that the study
was conducted during the era of widespread public information and
education campaigns regarding the association of risk of human
immunodeficiency virus infection and unprotected anal intercourse.
Future investigations should examine such variables as the relational
context of the behavior (eg, was it within an established relationship?
Was it extramarital or extrarelational?), the relevance of orgasm (some
consider behaviors less intimate if no orgasm occurs), issues of
consent, the relevance of cohort and socioeconomic status to
definitions of what constitutes sex, and the potential costs/benefits
of labeling a behavior as having "had sex" (eg, in cases of
extramarital behavior, discrepancies between partners are likely).
The virtually universal endorsement of penile-vaginal
intercourse as having "had sex" in contrast with the diverse
opinions for other behaviors highlights the primacy of penile-vaginal
intercourse in American definitions of having "had sex." The lack
of consensus with respect to what constitutes having "had sex"
across the sexual behaviors examined herein provides empirical evidence
of the need for behavioral specificity when collecting data on sexual
histories and identifying sexual partners. These data indicate that
prior to the current public discourse, a majority of college students
attending a major midwestern state university, most of whom identified
themselves as politically moderate to conservative, with more
registered Republicans than Democrats, did not define oral sex as
having "had sex."
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