The phrase “having sex” means different things to different people. Most people agree that penile-vaginal intercourse counts as sex and that if you’ve had penile-vaginal intercourse with a person then you’ve “had sex” with them and that the person counts as a sexual partner. However, what counts as sex isn’t always so cut and dry (and can vary by age, gender, and self-identified sexual orientation among other factors).
When I first began working at The Kinsey Institute in 1999, a study that one of my mentors – Dr. Stephanie Sanders – conducted with her colleague, Dr. June Reinisch, that had examined college students’ meanings of having “had sex” was newly published. The study made waves in large part because it came at a time when Americans and politicians in particular were debating whether oral sex was sex, and thus whether President Bill Clinton was being truthful when he said he had not “had sex with that woman”.
Their study had been conducted years earlier and so the results weren’t influenced by public opinion in relation to the Clinton-Lewinsky affair. What Drs. Sanders and Reinisch found was that many college students surveyed wouldn’t count someone they had only had oral sex with as a sexual partner. Similarly, only about half of women and men surveyed considered oral sex to be “real sex” (questions about other behaviors were asked as well).
I thought of this study tonight because of a line in Girls when Hannah says, “That wasn’t sex; you came in my thigh crease”, suggesting that she too has her own definition of sex and where penetration occurs likely has something to do with it. Vaginal sex? Likely “sex” for her. Humping and then ejaculating on her thighs? Maybe not so much.
Years ago during grad school, I worked on a research study with young women and, as part of the study, we asked the women about their sexual partners including the people they had engaged in oral, vaginal, or anal sex (we did not, I should note, ask about men who “came in their thigh crease” as per Girls – though perhaps that would have made for a more colorful study!). While working on that study, it was interesting to me to discover how the young women in the study considered their sex partners. Some women wouldn’t count a man as one of her sex partners if the sex wasn’t good/pleasurable, if it didn’t last very long, or if she no longer liked him or was no longer talking to him. Others counted every man as a sex partner so long as she had had vaginal sex with him.
From a public health perspective, this type of research matters because it helps us understand what people mean when they say they had sex, or haven’t had sex. Many doctors and nurses can tell you stories of patients they’ve had who had sworn they had never “had sex” but then tested positive for a sexually transmissible infection (STI) or were pregnant. When confronted with the positive STI test or the pregnancy, and asked how that could be if they had never had sex, the patients often say things like “well, it was really quick” or “I didn’t count him” or “it wasn’t any good”. Of course, pathogens and sperm don’t care if the sex was bad – one can still pass an STI or create a pregnancy even during quick, unpleasurable sex.
If your healthcare provider asks about your sex partners, try to be over-inclusive - let your provider know if you’ve had oral sex, vaginal sex, and/or anal sex. If you’ve had anal sex, for example, you’ll want to be tested for rectal STIs – one can have chlamydia in the vagina or urethra as well as in the anus/rectum, so more than one test can be helpful. Unfortunately, many people who engage in anal sex don’t think to ask for rectal STI testing and may not even know that it exists or is available to them.
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