Oral Sex

Oral sex used to be something that was only practised by a minority of couples. But in 2014, it seems likely that the majority of sexually-active people do it at times.
Indeed, in the UK the National Survey on Sexual Attitudes and Lifestyles has just reported that the percentages of people who say that they have gone in for oral sex during the last year are as follows:

• 71 per cent of 16 to 24 year olds
• 80 per cent of 25 to 34 year olds
• 78 percent of 35 to 44 year olds
• 67 per cent of 45 to 54 year olds
• 52 per cent of males and 35 per cent of females 55 to 64 year olds
• 30 per cent of males and 19 oer cent of females 65-plus.

In the USA, broadly similar figures have been reported by the authoritative Center for Disease Control and Prevention.
Oral sex has many advantages, but one serious concern about it has recently emerged – the risk of throat cancer, caused by human papilloma virus (HPV).
Also, I attended a conference in 2011, where it became clear that chlamydia infection is now a possible hazard of oral sex – particularly if you are promiscuous or do it with a promiscuous partner.

Advantages of oral sex

But what are the advantages of oral love play?
Well, although it's not everyone's cup of tea, for a lot of people oral sex is fun. It can help 'spice up' a relationship. Oral stimulation given to a woman is often an excellent way of getting her aroused. Also, if it's practised by a reasonably expert partner, it's an extremely effective method of giving her an orgasm.
Many women who have had difficulty in climaxing find that oral sex helps them to 'come'.
Similarly, oral sex given to a man is something that many males find exciting. Also, where an older man is having difficulties with potency, oral 'suction' by his partner can help with inducing a good erection.

What types are there?

There are two main types of oral sex. Sometimes a couple will engage in both of them at the same time.
Performed on a woman: oral sex given to a woman by her partner (whether male or female) is called 'cunnilingus'. In old books, you may well see this spelt as 'cunnilinctus'. Generally, the idea is to kiss and lick all of the vulva, but eventually to concentrate on the area round the woman's clitoris.
Performed on a man: oral sex given to a man by his partner (again, female or male) is generally termed fellatio, though strictly speaking this word only covers the type of oral caress in which the penis actually enters the partner's mouth.
Some couples practise cunnilingus and fellatio at the same time. In other words, the man has his mouth on the woman's genitals, while she has her mouth on his.
This activity is widely known as 'the 69' or 'le soixante-neuf', because of the notion that when viewed from the side, the couple's bodies look a bit like the figures '6' and '9'.

Cunnilingus

Cunnilingus can be intensely exciting for many women. It's also satisfying for a man who enjoys giving his partner intense pleasure.
However, for 'first-timers' it can be a somewhat overwhelming experience. So, if either of you is just learning and isn't used to this type of thing, it's a good idea to take things easy at the beginning.
Therefore, the man should avoid making a sudden lunge for his partner's genitals. A gradual approach is usually better, taking care to kiss her tummy and thighs before slowly progressing to her vulva. (The vulva is the external and visible part of the female genitals.)
Useful tips include:

• take care to keep things moist
• begin by gently kissing the entire area of the vulva
• later, progress to kissing the clitoral region
• in the early stages, avoid direct pressure on the clitoris, which is a very sensitive organ
• kiss just to one side of it, or just above it – at least, during the first few minutes of cunnilingus.

The most intense stimulation is generally provided by using the tip of your tongue on the clitoral area. If properly done, this will bring most women to a climax.

Fellatio

As noted above, the word fellatio really means putting your partner's penis in your mouth. But women who are skilled lovers will also go in for such techniques as kissing the penis and licking it.
In addition, they may give oral attention to the man's testicles, although this is nothing like as intensely arousing as 'working' on the penis – since there are far more nerve endings in the penile shaft and head.
Having a penis enter your mouth can be a bit of a shock for an inexperienced woman. However, a lot of females get used to it, and indeed like it.
Nevertheless, the man should take great care not to 'ram' his organ hard into his partner's mouth. This can cause great discomfort and even gagging.
From the male point of view, the softness, warmth and moisture of the mouth clearly 'mimic' the qualities of the vagina.
In addition, a partner's mouth has two attributes that the vagina does not possess.

• There's a tongue – and this can be used to swirl around the penis during fellatio.
• The mouth can create suction – and this can be useful in creating and maintaining an erection.

On the downside, the mouth has teeth – and you need to take care not to dig them into your man. Some women make a practice of covering their incisor teeth with their lips during fellatio, but this is quite difficult.

Fellatio and the male orgasm

Some couples just go in for fellatio for a few seconds or a few minutes, and then progress to something else – like intercourse.
However, often they agree that the woman will continue fellating the man until he reaches orgasm. This raises some difficulties.
If you're female, it's important that you should realise that there's something primitive in the male psyche that gives him a strong desire to 'discharge' his seed inside a woman. That is one reason why the human race has survived so long!
So the curious fact is that a lot of men actually want to reach a climax inside your mouth. And some of them desperately want you to then swallow their semen.
Indeed, I can assure you that quite a few rather silly young males get resentful or feel rejected if you do not agree to let them 'come' in your mouth, or if you refuse to swallow.
Unfortunately, their views have been reinforced by a good deal of present-day pornography – especially on the internet – which tends to suggest that:

• women love the taste of semen
• they like nothing better than swallowing it – except perhaps 'sharing' it with their female friends, through French-kissing them.

In fact, none of this is true. It’s just a pornographer’s fantasy. Seminal fluid does not taste particularly nice, and in consistency, it's reminiscent of uncooked egg white.
So, if you're a woman, don't let yourself be pressured into doing something that you don't want to. And if you're a man, please don't try and blackmail your partner into letting you come inside her mouth.
There are ways of getting round the problem. For instance, many couples agree that the guy will 'withdraw' at the last second. In other cases, the woman may agree to the idea of letting her man discharge inside her mouth – but will then spit the fluid out.
Having said all that, for completeness I must add that there really are some highly-sexed women who do enjoy having a partner 'go all the way' in their mouths. Generally, they seem to feel that this is a tribute to their attractiveness and sexiness.

The new dangers in oral sex

So, oral sex has many advantages, and a lot of couples find it a really fulfilling part of their bedroom repertoire.
Also, it's nearly impossible to get pregnant this way!

Human papilloma virus (HPV)

However, in this century a new and serious concern about oral sex has emerged.
You're probably aware that there is a very widespread virus called human papilloma virus (HPV). It causes cancer of the cervix, cancer of the anus and some other benign and malignant growths – including genital warts. There have even been suggestions in 2013 that it might be a cause of some cases of lung cancer.
In 2006, scientists began to pay attention to an oncologist (cancer researcher) called Maura Gillson, based at John Hopkins University. She had been pointing out for some years that:

• the incidence of a type of mouth and throat cancer is rising
• the increase has been happening in people who don't have traditional 'risk factors', like smoking and drinking
• this type of cancer is often associated with the presence of HPV in the throat.

In 2010, the British Medical Journal published a multinational review which showed that there's no doubt that the incidence of this particular form of cancer (oropharyngeal squamous cell carcinoma) is increasing in various western countries, and this rise appears to be due to HPV – particularly a strain called HPV-16.
The authors stated that the risk of developing oropharyngeal cancer is associated with a history of having six or more sexual partners – and of having four or more oral sex partners.
The obvious implication is that the virus is being spread by sex, and particularly by oral sex.
This is certainly bad news for people who like oral contact. However, at the moment it is hoped that there's little danger to a monogamous couple, who only have oral sex with each other.
But suddenly, promiscuous oral sex seems like a very bad idea.
In the next few years, much more will be learned about this subject. My forecast is that the modern anti-HPV vaccines (Gardasil and Cervarix) will be used much more widely, in order to combat this unexpected danger, apparently caused by the widespread use of oral sex.

Chlamydia and gonorrhoea

Another concern that has recently arisen is the question of catching chlamydia through oral sex.
In May 2011, I attended a large international conference in Gateshead, at which Dr Indrajit Ghosh and his colleagues revealed the results of their screening programme among female commercial sex workers (FCSWs) in London.
They found that one in every 25 of these women had chlamydia in the throat. It seems certain that they had acquired the germ through offering fellatio to customers. Additionally, one in every 50 of the FCSWs had unsuspected gonorrhoea in the throat.
This research makes it clear that oral sex is not quite as safe as it may have seemed a few years ago – except of course if you only do it with one partner.

Summing up

Oral sex is very good fun, and it can help a lot with the physical side of a relationship. These days, most couples do it at times.
But it's best if you only do it with your regular partner, and not with someone 'casual'. However, don't get too alarmed by the recent research; most people who catch HPV do not get cancer.

Written by Dr David Delvin, GP and family planning specialist