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Clinical use and implications of sexual devices and sexually explicit media

Abstract

Given that sexual pleasure is a core component of sexual health, devices that are designed to enhance and diversify sexual pleasure are particularly useful in clinical practice. Despite their growing popularity and widespread use in various biopsychosocial circumstances, many taboos still seem to exist, as indicated by the paucity of scientific literature on the prevalence, application and effectiveness of sexual devices for therapeutic use. However, sex toys and sexual devices are commonly used and have a variety of indications to expand individual and partnered sexuality and to treat sexual difficulties. Different devices are associated with specific advantages and potential risks, opportunities, barriers and ethical challenges when used in a clinical context. Increased knowledge about the aim and functional possibilities of sexual devices might help health-care professionals overcome potential embarrassment, preconceptions and other barriers, learn which patients might benefit from which products, consider their use in treatment programmes, educate about correct use and safety issues, and facilitate open communication about sexual pleasure with their patients.

Key points

  • Sexual devices are primarily designed to improve sexual well-being, pleasure, recreation, freedom and diversity.

  • Despite the increasing accessibility and popularity of sexual devices in society, for some health-care professionals in clinical practice they remain a taboo subject.

  • Health-care professionals should be encouraged to keep an open mind around the use of sexual devices and to assist their clients in obtaining the knowledge and skills necessary for their correct and safe use.

  • Sexual devices are commonly used and have a variety of indications to expand individual and partnered sexuality and to assist in the treatment of sexual difficulties.

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References

  1. Brotto, L. A. & Smith, K. B. In APA Handbook of Sexuality and Psychology Vol. 1 (eds Tolman D. L. & Diamond, L. M.) p. 205–244 (American Psychological Association, 2014) [APA handbooks in psychology].

  2. World Health Organization. Sexual and reproductive health and research including the Special Programme HRP. WHO https://www.who.int/reproductivehealth/topics/sexual_health/sh_definitions/en/ (2020).

  3. Meston, C. M. & Buss, D. M. Why humans have sex. Arch. Sex. Behav. 36, 477–507 (2007).

    PubMed  Google Scholar 

  4. Piha, S., Hurmerinta, L., Järvinen, E., Räikönen, J. & Sandberg, B. Escaping into sexual play: a consumer experience perspective. Leis. Sci. 42, 289–305 (2020).

    Google Scholar 

  5. Rubin, E. S., Deshpande, N. A., Vasquez, P. J. & Kellogg Spadt, S. A clinical reference guide on sexual devices for obstetrician-gynecologists. Obstet. Gynecol. 133, 1259–1268 (2019).

    PubMed  Google Scholar 

  6. Queen, C. Sexual enhancement products. J. Sex. Med. 10, 3155–3156 (2013).

    PubMed  Google Scholar 

  7. Rosenberger, J. G., Schick, V., Herbenick, D., Novak, D. S. & Reece, M. Sex toy use by gay and bisexual men in the United States. Arch. Sex. Behav. 41, 449–458 (2012).

    PubMed  Google Scholar 

  8. Doring, N. & Poeschl, S. Sex toys, sex dolls, sex robots: our under-researched bed-fellows. Sexologies 27, e51–e55 (2018).

    Google Scholar 

  9. Rivera, D. Sex toys through the ages. DailyOjo http://dailyojo.com/articles/sex-toys-through-the-ages.html (2009).

  10. Starr, K. E. & Aron, L. Women on the couch: genital stimulation and the birth of psychoanalysis. Psychoanal. Dialogues 21, 373–392 (2011).

    Google Scholar 

  11. Laqueur, T. Solitary Sex: a Cultural History of Masturbation (Zone Books, 2003).

  12. Marcus, B. S. Changes in a woman’s sexual experience and expectations following the introduction of electric vibrator assistance. J. Sex. Med. 8, 3398–3406 (2011).

    PubMed  Google Scholar 

  13. Albrecht, L. Home Sex Toy Parties: a Non-Traditional, Uniquely Situated Venue of Sexuality Education for Women (University of Alberta, 2012).

  14. Herbenick, D. et al. Prevalence and characteristics of vibrator use by women in the United States: results from a nationally representative study. J. Sex. Med. 6, 1857–1866 (2009).

    PubMed  Google Scholar 

  15. Reece, M. et al. Prevalence and characteristics of vibrator use by men in the United States. J. Sex. Med. 6, 867–1874 (2009).

    Google Scholar 

  16. Reece, M. et al. Characteristics of vibrator use by gay and bisexually identified men in the United States. J. Sex. Med. 7, 3467–3476 (2010).

    PubMed  Google Scholar 

  17. Döring, N. & Poeschl, S. Experiences with diverse sex toys among German heterosexual adults: findings from a national online survey. J. Sex. Res. 57, 885–896 (2020).

    PubMed  Google Scholar 

  18. Wikipedia. Anti-Obscenity Enforcement Act. Wikipedia https://en.wikipedia.org/wiki/Anti-Obscenity_Enforcement_Act# (2020).

  19. The LGBT Sentinel. Traveling with sex toys could land you in trouble. The LGBT Sentinel http://www.thelgbtsentinel.com/traveling-sex-toys-land-trouble/ (2020).

  20. Jannini, E. A., Limoncin, E., Ciocca, G., Buehler, S. & Krychman, M. Ethical aspects of sexual medicine. Internet, vibrators, and other sex aids: toys or therapeutic instruments. J. Sex. Med. 9, 2994–3001 (2012).

    PubMed  Google Scholar 

  21. NAASAS. Adult novelties: sex toys, adult toys, marital aids, sexual health and pleasure products. NAASAS https://naasas.com/adult-novelties.htm (2020).

  22. FDA. CFR – Code of Federal Regulations Title 21: clitoral engorgement device. FDA https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=884.5970 (2020).

  23. FDA. CFR – Code of Federal Regulations Title 21: powered vaginal muscle stimulator for therapeutic use. FDA https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=884.5940 (2020).

  24. Lewis, R. W. & Witherington, R. External vacuum therapy for erectile dysfunction: use and results. World J. Urol. 15, 78–82 (1997).

    CAS  PubMed  Google Scholar 

  25. FDA. CFR – Code of Federal Regulations Title 21: external penile rigidity devices. FDA https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=876.5020 (2020).

  26. FDA. External penile rigidity devices – Class II: special controls guidance document for industry and FDA staff. FDA https://www.fda.gov/medical-devices/external-penile-rigidity-devices-class-ii-special-controls-guidance-document-industry-and-fda-staff (2018).

  27. Department of Health & Human Services. Viberect penile vibratory stimulation device. FDA https://www.accessdata.fda.gov/cdrh_docs/pdf14/K142304.pdf (2014).

  28. Gill, D. G. Human sexuality, ethical issues and the medical profession. Mid Am. Rev. Sociol. 7, 3–28 (1982).

    CAS  PubMed  Google Scholar 

  29. Council of Europe. Sexuality. Council of Europe https://www.coe.int/en/web/gender-matters/sexuality (2020).

  30. American University of Beirut. “Sexual rights are human rights; what about sexual pleasure?” – AUB panel on Human Rights Day. American University of Beirut https://www.aub.edu.lb/fhs/news/Pages/sexualrights_nasss.aspx (2017).

  31. Richters, J. Sex in Australia: autoerotic, esoteric and other sexual practices engaged in by a representative sample of adults. Aust. N. Z. J. Public Health 27, 180–190 (2003).

    PubMed  Google Scholar 

  32. Wood, J., Cran, S., Cunningham, S., Money, D. & O’Doherty, K. Cross-sectional survey of sex toy use, characteristics of sex toy use hygiene behaviours, and vulvovaginal health outcomes in Canada. Can. J. Hum. Sexuality 26, 196–204 (2017).

    Google Scholar 

  33. Bauer, G. R. et al. Factors impacting transgender patients’ discomfort with their family physicians: a respondent-driven sampling survey. PLoS ONE 17, e0145046 (2015).

    Google Scholar 

  34. Joyal, C. C. & Carpentier, J. The prevalence of paraphilic interests and behaviors in the general population: a provincial survey. J. Sex. Res. 54, 161–171 (2017).

    PubMed  Google Scholar 

  35. Maddox, A. M., Rhoades, G. K. & Markman, H. J. Viewing sexually-explicit materials alone or together: associations with relationship quality. Arch. Sex. Behav. 40, 441–448 (2011).

    PubMed  Google Scholar 

  36. Döring, N. & Mohseni, M. R. Are online sexual activities and sexting good for adults’ sexual well-being? Results from a national online survey. Int. J. Sex. Health 30, 250–263 (2018).

    Google Scholar 

  37. Statista. How often do you use sex toys? Statista https://www.statista.com/forecasts/744534/use-frequency-of-sex-toys-by-female-consumers-in-the-us#:~:text=When%20it%20comes%20to%20the,they%20use%20sex%20toys%20daily.&text=The%20global%20sex%20toy%20market%20is%20growing (2021).

  38. Rohleder, P. & Swartz, L. In Understanding Global Sexualities: New Frontiers (eds Aggleton, P., Boyce, P., Moore, H. L. & Parker, R.) 138–152 (Routledge, 2012).

  39. Rullo, J. E. et al. Genital vibration for sexual function and enhancement: a review of evidence. Sex Relation Ther. 33, 263–274 (2018).

    PubMed  PubMed Central  Google Scholar 

  40. Miranda, E. P. et al. Application of sex aids in men with sexual dysfunction: a review. J. Sex. Med. 16, 1–14 (2019).

    Google Scholar 

  41. Barrett, C. & Hinchliff, S. (eds) Addressing the Sexual Rights of Older People: Theory, Policy and Practice (Routledge, 2017).

  42. Reisman, Y. & Gianotten W. L. (eds) in Cancer, Intimacy and Sexuality (eds Reisman, Y. & Gianotten W. L.) 223–234 (Springer, 2017).

  43. Bober, S. L. et al. Finding sexual health aids after cancer: are cancer centers supporting survivors’ needs? J. Cancer Surviv. 13, 224–230 (2019).

    PubMed  Google Scholar 

  44. Syrjala, K. L. Filling the gaps in knowledge and treatments for sexual health in young adult male cancer survivors. Cancer 122, 2134–2137 (2016).

    PubMed  PubMed Central  Google Scholar 

  45. Hill, E. K. et al. Assessing gynecologic and breast cancer survivors’ sexual health care needs. Cancer 117, 2643–2651 (2011).

    PubMed  Google Scholar 

  46. Albers, L. F. et al. Sexual health needs: how do breast cancer patients and their partners want information? J. Sex Marital Ther. 46, 205–226 (2020).

    CAS  PubMed  Google Scholar 

  47. Schroder, M. A. et al. Clitoral therapy device for treatment of sexual dysfunction in irradiated cervical cancer patients. Int. J. Radiat. Oncol. Biol. Phys. 61, 1078–1086 (2005).

    PubMed  Google Scholar 

  48. National Forum of Gynecological Oncology Nurses, UK. International Guidelines on vaginal dilation after pelvic radiotherapy. OwenMumford https://owenmumford.com/us/wp-content/uploads/sites/3/2014/11/Dilator-Best-Practice-Guidelines.pdf (2012).

  49. Liu, M., Juravic, M., Mazza, G. & Krychman, M. L. Vaginal dilators: issues and answers. Sex. Med. Rev. 31, 30125–30128 (2020).

    Google Scholar 

  50. Morales, E. et al. Co-designing sex toys for adults with motor disabilities. Sex. Disabil. 36, 47–68 (2018).

    Google Scholar 

  51. Tepper, M. S. Sexuality and disability: the missing discourse of pleasure. Sex. Disabil. 18, 283–290 (2000).

    Google Scholar 

  52. Naphtali, K. et al. PleasureAble: sexual device manual for persons with disabilities (Disabilities Health Research Network, 2009).

  53. Dennis, C. Brain development: the most important sexual organ. Nature 427, 390–392 (2004).

    CAS  PubMed  Google Scholar 

  54. Alptraum, L. How to design sex toys for people with disabilities. VICE https://www.vice.com/en/article/9a3987/how-to-design-sex-toys-for-people-with-disabilities (2015).

  55. Spiel, K., Brulè, E., Nacke, L. E., Harrer, S. & Grenzfurthner, J. Sex Toys and Neurodiversity. Presented at the CHI Conference, Montreal https://www.researchgate.net/publication/324866087_Sex_Toys_and_Neurodiversity (2018).

  56. MacKenzie, A. Prejudicial stereotypes and testimonial injustice: autism, sexuality and sex education. Int. J. Educ. Res. 89, 110–118 (2019).

    Google Scholar 

  57. Michielsen, K. & Brockschmidt, L. Barriers to sexuality education for children and young people with disabilities in the WHO European region: a scoping review. Sex. Educ. https://doi.org/10.1080/14681811.2020.1851181 (2021).

    Article  Google Scholar 

  58. Hyde, Z. et al. Prevalence of sexual activity and associated factors in men aged 75 to 95 years a cohort study. Ann. Intern. Med. 153, 693–702 (2010).

    PubMed  Google Scholar 

  59. Kalra, G., Subramanyam, A. & Pinto, C. Sexuality: desire, activity and intimacy in the elderly. Indian J. Psychiat. 53, 300–306 (2011).

    Google Scholar 

  60. McCabe, M. P. et al. Definitions of sexual dysfunctions in women and men: a consensus statement from the Fourth International Consultation on Sexual Medicine 2015. J. Sex. Med. 13, 135–143 (2016).

    PubMed  Google Scholar 

  61. Worsley, R. et al. Hormones and female sexual dysfunction: beyond estrogens and androgens – findings from the Fourth International Consultation on Sexual Medicine. J. Sex. Med. 13, 283–290 (2016).

    PubMed  Google Scholar 

  62. Sonksen, J. & Ohl, D. A. Penile vibratory stimulation and electroejaculation in the treatment of ejaculatory dysfunction. Int. J. Androl. 25, 324–332 (2002).

    PubMed  Google Scholar 

  63. Fode, M., Ohl, D. & Sønksen, J. A step-wise approach to sperm retrieval in men with neurogenic anejaculation. Nat. Rev. Urol. 12, 607–616 (2015).

    PubMed  Google Scholar 

  64. Varsha, S. et al. Reproductive health of men with spinal cord injury. Top. Spinal. Cord. Inj. Rehabil. 23, 31–41 (2017).

    Google Scholar 

  65. Brackett, N. L. et al. Treatment for ejaculatory dysfunction in men with spinal cord injury: an 18-year single center experience. J. Urol. 183, 2304–2308 (2010).

    PubMed  Google Scholar 

  66. Nelson, C. J. et al. Assessment of penile vibratory stimulation as a management strategy in men with secondary retarded orgasm. Urology 69, 552–556 (2007).

    PubMed  PubMed Central  Google Scholar 

  67. Diamond, L. M. & Huebner, D. M. Is good sex good for you? Rethinking sexuality and health. Soc. Personal. Psychol. Compass 6, 54–69 (2012).

    Google Scholar 

  68. Lieberman, H. Selling sex toys: marketing and the meaning of vibrators in early twentieth-century America. Enterp. Soc. 17, 393–433 (2016).

    Google Scholar 

  69. Gomes, L. M. & Wu, R. TouchYou: a wearable touch sensor and stimulator for using our own body as a remote sex interface. Paladyn 11, 147–160 (2020).

    Google Scholar 

  70. Laan, E. et al. Standard operating procedures for female orgasmic disorder: consensus of the International Society for Sexual Medicine. J. Sex. Med. 10, 74–82 (2013).

    PubMed  Google Scholar 

  71. Leff, J. J. & Israel, M. The relationship between mode of female masturbation and achievement of orgasm in coitus. Arch. Sex. Behav. 12, 227–236 (1983).

    CAS  PubMed  Google Scholar 

  72. Mintz, L. B. & Guiltelman, J. in Principles and Practice of Sex Therapy 6th edn (eds Hall, S. K. H. & Binik, Y. M.) 109–120 (Guilford, 2020).

  73. Gruenwald, I. et al. Female sexual orgasmic dysfunction and genital sensation deficiency. J. Sex. Med. 17, 273–278 (2020).

    PubMed  Google Scholar 

  74. Guess, M. K. et al. The effects of a genital vibratory stimulation device on sexual function and genital sensation. Female Pelvic Med. Reconstr. Surg. 23, 256–262 (2017).

    PubMed  Google Scholar 

  75. Graham, C. A. in Principles and Practice of Sex Therapy 5th edn (eds Binik Y. M. & Hall K. S. K.) 89–111 (Guilford, 2014).

  76. Watson, E. D. et al. The impact of a couple’s vibrator on men’s perceptions of their own and their partner’s sexual pleasure and satisfaction. Men Masc. 19, 370–383 (2016).

    Google Scholar 

  77. Herbenick, D. et al. Association of lubricant use with women’s sexual pleasure, sexual satisfaction, and genital symptoms: a prospective daily diary study. J. Sex. Med. 8, 202–212 (2011).

    PubMed  Google Scholar 

  78. Herbenick, D. et al. Vibrators and other sex toys are commonly recommended to patients, but does size matter? Dimensions of commonly sold products. J. Sex. Med. 12, 641–645 (2015).

    PubMed  Google Scholar 

  79. Gilmore, P. Best cock rings to use with a partner and in a couple. Cosmopolitan https://www.cosmopolitan.com/uk/love-sex/sex/g12844366/best-cock-rings/ (2021).

  80. Phallophile Reviews.Womanizer vs. Satisfyer vs. Lelo Sona: best clit suction stimulators ranking. Phallophile Reviews https://phallophilereviews.com/womanizer-vs-satisfyer-vs-lelo-sona-best-clit-suction-stimulators/ (2019).

  81. Bilups, K. L. The role of mechanical devices in treating female sexual dysfunction and enhancing the female sexual response. World J. Urol. 20, 137–141 (2002).

    Google Scholar 

  82. Berman, L. A., Berman, J. R., Werbin, T., Chabra, S. & Goldstein, I. The use of the female intervention efficacy index (FIEI) as an immediate outcome measure of medical intervention to treat female sexual dysfunction. J. Sex. Marital. Ther. 27, 427–433 (2001).

    CAS  PubMed  Google Scholar 

  83. Gray, E. R. & Klotz, H. L. Restoring sexual function in prostate cancer patients: an innovative approach. Can. J. Urol. 11, 2285–2289 (2004).

    PubMed  Google Scholar 

  84. Warkentin, K. M. et al. Restoration of satisfying sex for a castrated cancer patient with complete impotence: a case study. J. Sex. Marital. Ther. 32, 389–399 (2006).

    PubMed  Google Scholar 

  85. Cullen, K. et al. From “sex toy” to intrusive imposition: a qualitative examination of women’s experiences with vaginal dilator use following treatment for gynecological cancer. J. Sex. Med. 9, 1162–1173 (2012).

    PubMed  Google Scholar 

  86. Ong, T. A. et al. Using the vibrance Kegel device with pelvic floor muscle exercise for stress urinary incontinence: a randomized controlled pilot study. Urology 6, 487–491 (2015).

    Google Scholar 

  87. Polak, J. T. & Davila, G. W. in Pelvic Floor Dysfunction (eds Davila, G. W., Ghoniem, G. M., & Wexner, S. D.) 109–110 (Springer, 2009).

  88. Dahlberg, M. et al. Retained sex toys: an increasing and possibly preventable medical condition. Int. J. Colorectal. Dis. 34, 181–183 (2019).

    PubMed  Google Scholar 

  89. Clark, J. L. et al. Frequency, patterns, and preferences of lubricant use during anal intercourse within male sexual partnerships in Lima, Peru: implications for a rectal microbicide HIV prevention intervention. AIDS Care. 25, 579–585 (2013).

    PubMed  Google Scholar 

  90. Levin, R. J. Prostate-induced orgasms: a concise review illustrated with a highly relevant case study. Clin. Anat. 31, 81–85 (2018).

    CAS  PubMed  Google Scholar 

  91. Shen, S. L. et al. Clinical trials of combined therapy of an oral Chinese medicine with massage for chronic nonbacterial prostatitis. Zhonghua Nan Ke Xue 12, 851–853 (2006).

    PubMed  Google Scholar 

  92. Ateya, A. et al. Evaluation of prostatic massage in treatment of chronic prostatitis. Urology 67, 674–678 (2006).

    PubMed  Google Scholar 

  93. Gilbert, H. W. & Gingell, J. C. Vacuum constriction devices: second-line conservative treatment for impotence. Br. J. Urol. 70, 81–83 (1992).

    CAS  PubMed  Google Scholar 

  94. Li, E. et al. The mechanism of vacuum constriction devices in penile erection: the NO/cGMP signaling pathway? Med. Hypo. 75, 422–424 (2010).

    CAS  Google Scholar 

  95. Wang, R. Vacuum erectile device for rehabilitation after radical prostatectomy. J. Sex. Med. 14, 184–186 (2017).

    PubMed  Google Scholar 

  96. Raina, R. et al. Early use of vacuum constriction device following radical prostatectomy facilitates early sexual activity and potentially earlier return of erectile function. Int. J. Impot. Res. 18, 77–81 (2006).

    CAS  PubMed  Google Scholar 

  97. Kohler, T. S. et al. A pilot study on the early use of vacuum erection device after radical retropubic prostatectomy. BJU Int. 100, 858–862 (2007).

    PubMed  Google Scholar 

  98. Haahr, M. K. et al. A retrospective study of erectile function and use of erectile aids in prostate cancer patients after radical prostatectomy in Denmark. Sex. Med. 5, e156–e162 (2017).

    PubMed  PubMed Central  Google Scholar 

  99. Reisman, Y. in Sikkelcelziekte een praktische handleiding (eds Schnog J. B., Brandjes, D. P. M., Duits, A. J., Rojer, R. A. & Muskiet, F. D.) (Van Zuiden, 2006).

  100. Korenman, S. G. et al. Use of a vacuum tumescence device in the management of impotence. J. Am. Geriatr. Soc. 38, 217–220 (1998).

    Google Scholar 

  101. Sidi, A. A. et al. Patient acceptance of and satisfaction with an external negative pressure device for impotence. J. Urol. 144, 1154–1156 (1990).

    CAS  PubMed  Google Scholar 

  102. Moore, O. Vacuum devices in erectile dysfunction: indications and efficacy. BJU Int. 82, 673–681 (1998).

    Google Scholar 

  103. Wylie, K. R. & Hallam-Jones, R. A. The combination of penoscrotal rings and PDE5i’s in the treatment of erectile dysfunction – the Sheffield PDE5i and ring duo technique. Two case reports. Sex. Relation. Ther. 21, 209–215 (2007).

    Google Scholar 

  104. Koifman, L. et al. Treatment options and outcomes of penile constriction devices. Int. Braz. J. Urol. 45, 384–391 (2019).

    PubMed  PubMed Central  Google Scholar 

  105. Ussher, J. M. et al. Sexual rehabilitation after prostate cancer through assistive aids: a comparison of gay/bisexual and heterosexual men. J. Sex. Res. 56, 854–869 (2019).

    PubMed  Google Scholar 

  106. Mehta, A., Deveci, S. & Mulhall, J. P. Efficacy of a penile variable tension loop for improving climacturia after radical prostatectomy. BJU Int. 111, 500–504 (2013).

    PubMed  Google Scholar 

  107. Rullo, J. E. et al. Genital vibration for sexual function and enhancement: best practice recommendations for choosing and safely using a vibrator. J. Sex. Relation. Ther. 33, 275–285 (2018).

    Google Scholar 

  108. Levin, R. J. The breast/nipple/areola complex and human sexuality. Sex. Relation. Ther. 21, 237–249 (2006).

    Google Scholar 

  109. Kinsey, A. C. et al. Sexual Behavior in the Human Female p. 587 (Indiana Univ., 1998).

  110. Boston Women’s Health Book Collective. The New Our Bodies, Ourselves: a Book by and for Women (Simon & Schuster, 1996).

  111. Goren, A. et al. Topical alpha-1 adrenergic receptor agonist applied to the nipple/areola complex improves female orgasmic function. J. Women Health 29, 1017–1020 (2020).

    Google Scholar 

  112. Komisaruk, B. & Whipple, B. Non-genital orgasms. Sex. Relation. Ther. 26, 356–372 (2011).

    Google Scholar 

  113. Reece, M. et al. Men’s use and perceptions of commercial lubricants: prevalence and characteristics in a nationally representative sample of American adults. J. Sex. Med. 11, 1125–1135 (2014).

    PubMed  Google Scholar 

  114. Statista. Usage of personal lubricants in the U.S. 2020. Statista https://www.statista.com/statistics/276824/us-households-usage-of-personal-lubricants/ (2021).

  115. Carballo-Diéguez, A. et al. Frequent use of lubricants for anal sex among men who have sex with men: the HIV prevention potential of a microbicidal gel. Am. J. Public Health 90, 1117–1121 (2000).

    PubMed  PubMed Central  Google Scholar 

  116. Dodge, B. et al. Frequency, reasons for, and perceptions of lubricant use among a nationally representative sample of self-identified gay and bisexual men in the United States. J. Sex. Med. 11, 2396–2405 (2014).

    PubMed  Google Scholar 

  117. Geibel, S. Condoms and condiments: compatibility and safety of personal lubricants and their use in Africa. J. Int. AIDS Soc. 16, 18531 (2013).

    PubMed  PubMed Central  Google Scholar 

  118. Brown, J. M. et al. Intravaginal practices and risk of bacterial vaginosis and candidiasis infection among a cohort of women in the United States. Obstet. Gynecol. 121, 773–780 (2013).

    PubMed  Google Scholar 

  119. Richters, J. & Donovan, J. G. B. Why do condoms break or slip off in use? An exploratory study. Int. J. STD AIDS 6, 11–18 (1995).

    CAS  PubMed  Google Scholar 

  120. Dewitte, M., Borg, C. & Lowenstein, L. A psychosocial approach to female genital pain. Nat. Rev. Urolog. 15, 25–41 (2018).

    Google Scholar 

  121. Laan, E. & Both, S. What makes women experience desire? Femin. Psychol. 18, 505–514 (2013).

    Google Scholar 

  122. Liberati, N. Teledildonics and new ways of “being in touch”: a phenomenological analysis of the use of haptic devices for intimate relations. Sci. Eng. Ethics. 23, 801–823 (2017).

    PubMed  Google Scholar 

  123. Wilson-Barnao, C. & Collie, N. The droning of intimacy: bodies, data, and sensory devices. Continuum. 32, 733–744 (2018).

    Google Scholar 

  124. Steensig, A. L. & Westh, J. Ø. Intimate Sensory Technology in Long Distance Relationships – a Thesis Study in the Sensescape of Teledildonics. Thesis, Aalborg University (2016).

  125. Levy, D. The Evolution of Human–Robot Relationships: Love and Sex with Robots (Harper, 2007).

  126. Richardson, K. Sex robot matters: slavery, the prostituted, and the rights of machines. IEEE. Technol. Soc. Mag. 35, 46–53 (2016).

    Google Scholar 

  127. Eichenberg, C., Khamis, M. & Hübner, L. The attitudes of therapists and physicians on the use of sex robots in sexual therapy: online survey and interview study. J. Med. Internet. Res. 21, e13853 (2019).

    PubMed  PubMed Central  Google Scholar 

  128. Cassidy, V. For the love of doll(s): a patriarchal nightmare of cyborg couplings. ESC 42, 203–215 (2016).

    Google Scholar 

  129. Doring, N., Mohseni, M. R. & Walter, R. Design, use, and effects of sex dolls and sex robots: scoping review. J. Med. Internet Res. 22, e18551 (2020).

    PubMed  PubMed Central  Google Scholar 

  130. Knox, D., Huff, S. & Chang, I. Sex dolls – creepy or healthy? Attitudes of undergraduates. J. Posit. Sexuality 3, 32–37 (2017).

    Google Scholar 

  131. Scheutz, M. & Arnold, T. in 2016 11th ACM/IEEE International Conference on Human Robot Interaction (HRI) 351–358 (IEEE, 2016).

  132. Nordmo, M., Næss, J. Ø., Husøy, M. F. & Arnestad, M. N. Friends, lovers or nothing: men and women differ in their perceptions of sex robots and platonic love robots. Front. Psychol. 11, 355 (2020).

    PubMed  PubMed Central  Google Scholar 

  133. Cheok, A. et al. in Handbook of Digital Games and Entertainment Technologies (eds Nakatsu, R., Rauterberg, M., Ciancarini, P.) 833–858 (Springer, 2017).

  134. Fosch-Villaronga, E. & Poulsen, A. Sex care robots. Paladyn 11, 1–18 (2020).

    Google Scholar 

  135. Jecker, N. S. Nothing to be ashamed of: sex robots for older adults with disabilities. J. Med. Ethics. 47, 26–32 (2021).

    PubMed  Google Scholar 

  136. Sprott, R. A. Reimagining “Kink”: transformation, growth, and healing through BDSM. J. Hum. Psychol. 20, 1–6 (2020).

    Google Scholar 

  137. Sprott, R. A. & Williams, D. J. Is BDSM a sexual orientation or serious leisure? Curr. Sex. Health Rep. 11, 75–79 (2019).

    Google Scholar 

  138. Sprott, R. A. & Benoit Hadcock, B. Bisexuality, pansexuality, queer identity and kink identity. Sex. Relation. Ther. 33, 214–232 (2018).

    Google Scholar 

  139. Anderson, J. & Paterek, E. Vaginal foreign body evaluation and treatment. in StatPearls [Internet]. (StatPearls, 2021).

  140. Friedman, M. A. et al. Vesicovaginal fistula: an unexpected consequence of changing sexual practices? Sex. Health 14, 394–396 (2017).

    PubMed  Google Scholar 

  141. Donaldson, J. F. et al. Obstructive uropathy and vesicovaginal fistula secondary to a retained sex toy in the vagina. J. Sex. Med. 11, 2595–2600 (2014).

    PubMed  Google Scholar 

  142. Cook, R. L. et al. Sexual behaviors and other risk factors for oral human papillomavirus infections in young women. Sex. Transm. Dis. 41, 486–492 (2014).

    PubMed  PubMed Central  Google Scholar 

  143. Kwakwa, H. A. & Ghobrial, M. W. Female-to-female transmission of human immunodeficiency virus. Clin. Infect. Dis. 36, e40–e41 (2003).

    PubMed  Google Scholar 

  144. Aaronson, D. S. & Shindel, A. W. Advocating for safer use of sexual enhancement products. J. Sex. Med. 7, 2285–2287 (2010).

    PubMed  Google Scholar 

  145. Marfatia, Y. S., Patel, D., Menon, D. S. & Naswa, S. Genital contact allergy: a diagnosis missed. Indian J. Sex. Transm. Dis. AIDS 37, 1–6 (2016).

    PubMed  PubMed Central  Google Scholar 

  146. Rutala, W. A., Weber, D. J. & Healthcare Infection Control Practices Advisory Committee. Disinfection and sterilization: guideline for disinfection and sterilization in healthcare facilities, 2008. CDC https://www.cdc.gov/infectioncontrol/guidelines/disinfection/#r11 (2019).

  147. Combs, C. A. & Fishman, A. A proposal to reduce the risk of transmission of human papilloma virus via transvaginal ultrasound. Am. J. Obstet. Gynecol. 215, 63–67 (2016).

    PubMed  Google Scholar 

  148. Chengalroyen, M. D. & Dabbs, E. R. The biodegradation of latex rubber: a minireview. J. Polym. Environ. 21, 874–880 (2013).

    CAS  Google Scholar 

  149. Anderson, T. A. et al. A study of human papillomavirus on vaginally inserted sex toys, before and after cleaning, among women who have sex with women and men. Sex. Transm. Infect. 90, 529–531 (2014).

    CAS  PubMed  Google Scholar 

  150. Brandt, R. C. & Martens, R. I. Shattering glass cookware. Am. Ceram. Soc. Bull. 91, 33–38 (2012).

    Google Scholar 

  151. Cantonwine, D. E. et al. Bisphenol A and human reproductive health. Expert Rev. Obstet. Gynecol. 8, 329–335 (2013).

    CAS  Google Scholar 

  152. Matuszczak, E. et al. The impact of bisphenol A on fertility, reproductive system, and development: a review of the literature. Int. J. Endocrinol. 2019, 4068717 (2019).

    PubMed  PubMed Central  Google Scholar 

  153. Kirana, P. S. et al. E-sexual health: a position statement of the European Society for Sexual Medicine. J. Sex. Med. 17, 1246–1253 (2020).

    PubMed  Google Scholar 

  154. Pornhub. The year 2019 in review. Pornhub INSIGHTS https://www.pornhub.com/insights/2019-year-in-review (2019).

  155. Döring, N. et al. Online sexual activity experiences among college students: a four-country comparison. Arch. Sex. Behavior. 46, 1641–1652 (2017).

    Google Scholar 

  156. Grov, C. et al. Perceived consequences of casual online sexual activities on heterosexual relationships: a US online survey. Arch. Sex. Behav. 40, 429–439 (2011).

    PubMed  Google Scholar 

  157. Shaughnessy, K., Byers, E. S., Clowater, S. L. & Kalinowski, A. Outcomes of arousal-oriented online sexual activities: perspectives from university and community samples. Arch. Sex. Behav. 43, 1187–1197 (2013).

    PubMed  Google Scholar 

  158. Rissel, C. et al. A profile of pornography users in Australia: findings from the second Australian study of health and relationships. J. Sex. Res. 54, 227–240 (2016).

    PubMed  Google Scholar 

  159. Grubbs, J. B., Kraus, S. W. & Perry, S. L. Self-reported addiction to pornography in a nationally representative sample: the roles of use habits, religiousness, and moral incongruence. J. Behav. Addict. 8, 88–93 (2018).

    Google Scholar 

  160. Dwulit, A. D. & Rzymski, P. The potential associations of pornography use with sexual dysfunctions: an integrative literature review of observational studies. J. Clin. Med. 8, 914 (2019).

    PubMed Central  Google Scholar 

  161. Bélanger Lejars, V. O., Bélanger, C. H. & Razmak, J. Exploring new measures of online sexual activities, device use, and gender differences. Comput. Hum. Behav. 108, 106300 (2020).

    Google Scholar 

  162. Maas, M. K. & Dewey, S. Internet pornography use among collegiate women: gender attitudes, body monitoring, and sexual behavior. SAGE Open https://doi.org/10.1177/2158244018786640 (2018).

    Article  Google Scholar 

  163. Kohut, T. et al. Pornography’s associations with open sexual communication and relationship closeness vary as a function of dyadic patterns of pornography use within heterosexual relationships. J. Soc. Pers. Relat. 35, 655–675 (2018).

    Google Scholar 

  164. Willoughby, B., Leonhardt, N. & Augustus, R. Untangling the porn web: creating an organizing framework for pornography research among couples. J. Sex. Res. 57, 709–721 (2020).

    PubMed  Google Scholar 

  165. Carroll, J. S., Busby, D. M., Willoughby, B. J. & Brown, C. The porn gap: differences in men’s and women’s pornography patterns in couple relationships. J. Couple Relation. Ther. 16, 146–163 (2017).

    Google Scholar 

  166. Wiederman, M. W. The gendered nature of sexual scripts. Fam. J. 13, 496–502 (2005).

    Google Scholar 

  167. Cowan, G. & Campbell, R. R. Rape causal attitudes among adolescents. J. Sex. Res. 32, 145–153 (1995).

    Google Scholar 

  168. Klaasen, M. J. E. & Peter, J. Gender (in)equality in internet pornography: a content analysis of popular pornographic internet videos. J. Sex. Res. 52, 721–735 (2015).

    Google Scholar 

  169. Rosted, W. L. et al. The association between exposure to violent pornography and teen dating violence in grade 10 high school students. Arch. Sex. Behav. 48, 2137–2147 (2019).

    Google Scholar 

  170. Hald, G. M., Malamuth, N. M. & Yuen, C. Pornography and attitudes supporting violence against women: revisiting the relationship in nonexperimental studies. Aggress. Behav. 36, 14–20 (2010).

    PubMed  Google Scholar 

  171. Vangeel, L., Eggermont, S. & Vandenbosch, L. Does adolescent media use predict sexual stereotypes in adolescence and emerging adulthood? Associations with music television and online pornography exposure. Arch. Sex. Behav. 49, 1147–1161 (2020).

    PubMed  Google Scholar 

  172. Mori, C. et al. Association of sexting with sexual behaviors and mental health among adolescents: a systematic review and meta-analysis. JAMA Pediatr. 173, 770–779 (2019).

    PubMed  PubMed Central  Google Scholar 

  173. Peter, J. & Valkenburg, P. M. Adolescents and pornography: a review of 20 years of research. J. Sex. Res. 53, 509–531 (2016).

    PubMed  Google Scholar 

  174. Aiken, M. The Cyber Effect: a Pioneering Cyberpsychologist Explains How Human Behavior Changes Online (John Murray, 2017).

  175. Massey, K., Burns, J. & Franz, A. Young people, sexuality and the age of pornography. Sex. Cult. 25, 318–336 (2021).

    Google Scholar 

  176. Sevic, S. et al. The relationship between the use of social networking sites and sexually explicit material, the internalization of appearance ideals and body self-surveillance: results from a longitudinal study of male adolescents. J. Youth Adolesc. 49, 383–398 (2020).

    PubMed  Google Scholar 

  177. Paslakis, G., Chiclana Actis, C. & Mestre-Bach, G. Associations between pornography exposure, body image and sexual body image: a systematic review. J. Health Psychol. https://doi.org/10.1177/1359105320967085 (2020).

    Article  PubMed  Google Scholar 

  178. Hald, G. M. et al. Does viewing explain doing? Assessing the association between sexually explicit materials use and sexual behaviors in a large sample of Dutch adolescents and young adults. J. Sex. Med. 10, 2986–2995 (2013).

    PubMed  Google Scholar 

  179. Arrington-Sanders, R. et al. The role of sexually explicit material in the sexual development of same-sex-attracted black adolescent males. Arch. Sex. Behav. 44, 597–608 (2015).

    PubMed  PubMed Central  Google Scholar 

  180. Litsou, K., Byron, P., McKee, A. & Ingham, R. Learning from pornography: results of a mixed methods systematic review. Sex Educ. 21, 236–252 (2021).

    Google Scholar 

  181. Willoughby, B. J. & Leonhardt, N. D. Behind closed doors: individual and joint pornography use among romantic couples. J. Sex. Res. 57, 77–91 (2020).

    PubMed  Google Scholar 

  182. Lin, W. H., Liu, C. H. & Yi, C. C. Exposure to sexually explicit media in early adolescence is related to risky sexual behavior in emerging adulthood. PLoS ONE 15, e0230242 (2020).

    CAS  PubMed  PubMed Central  Google Scholar 

  183. Minarcik, J., Wetterneck, C. T. & Short, M. B. The effects of sexually explicit material use on romantic relationship dynamics. J. Behav. Addict. 5, 700–707 (2016).

    PubMed  PubMed Central  Google Scholar 

  184. Park, B. Y. et al. Is internet pornography causing sexual dysfunctions? A review with clinical reports. Behav. Sci. 6, 17 (2016).

    Google Scholar 

  185. Duffy, A., Dawson, D. L. & das Nair, R. Pornography addiction in adults: a systematic review of definitions and reported impact. J. Sex. Med. 13, 760–777 (2016).

    PubMed  Google Scholar 

  186. Gutiérrez-Puertas, L. et al. Online sexual activities among university students: relationship with sexual satisfaction. An. Psych. 36, 166–172 (2020).

    Google Scholar 

  187. Wright, P. J. & Tokunaga, R. S. Women’s perceptions of their male partners’ pornography consumption and relational, sexual, self, and body satisfaction: toward a theoretical model. Ann. Int. Commun. Assoc. 42, 55–73 (2018).

    Google Scholar 

  188. Hesse, C. & Pedersen, C. L. Porn sex versus real sex: how sexually explicit material shapes our understanding of sexual anatomy, physiology, and behaviour. Sex. Cult. 21, 754–775 (2017).

    Google Scholar 

  189. Robinson, B. B. E. et al. Therapeutic uses of sexually explicit materials in the United States and the Czech and Slovak republics: a qualitative study. J. Sex. Marital. Therapy. 25, 103–119 (1999).

    CAS  Google Scholar 

  190. Brewster, M. & Wylie, K. R. The use of sexually explicit material in clinical, educational and research settings in the United Kingdom and its relation to the development of psychosexual therapy and sex education. Sex. Educ. 8, 381–398 (2008).

    Google Scholar 

  191. Træen, B., Nilsen, T. S. & Stigum, H. Use of pornography in traditional media and on the internet in Norway. J. Sex. Res. 43, 245–254 (2006).

    PubMed  Google Scholar 

  192. Quilliam, S. Everything you ever wanted to know about sex toys but were too afraid to ask. J. Fam. Plann. Reprod. Health Care 33, 129–130 (2007).

    PubMed  Google Scholar 

  193. Dyer, K. & das Nair, R. Why don’t healthcare professionals talk about sex? A systematic review of recent qualitative studies conducted in the United Kingdom. J. Sex. Med. 10, 2658–2670 (2013).

    PubMed  Google Scholar 

  194. Krychman, M. & Millheiser, L. S. Sexual health issues in women with cancer. J. Sex. Med. 10, 5–15 (2013).

    CAS  PubMed  Google Scholar 

  195. Pinkerton, S. D. et al. The pleasures of sex: an empirical investigation. Cogn. Emot. 17, 341–353 (2003).

    PubMed  Google Scholar 

  196. Washington, K. Lieberman, Hallie. Buzz: a stimulating history of the sex toy. J. Sex Marital Ther. 44, 613–614 (2018).

    Google Scholar 

  197. Wood, R. Consumer sexualities: women and sex shopping (Routledge, 2017).

  198. Frith, H. Orgasmic bodies: the orgasm in contemporary Western culture (Palgrave Macmillan, 2015).

  199. Lieberman, H. Intimate transactions: sex toys and the sexual discourse of second-wave feminism. Sex. Cult. 21, 96–120 (2017).

    Google Scholar 

  200. Bloom, J. Reading the Male Gaze in Literature and Culture: Studies in Erotic Epistemology (Springer, 2017).

  201. Comella, L. Vibrator Nation: How Feminist Sex-Toy Stores Changed the Business of Pleasure (Duke Univ., 2017).

  202. Davis, C. M. et al. Characteristics of vibrator use among women. J. Sex. Res. 33, 313–320 (1996).

    Google Scholar 

  203. Wong, K. The sex tech revolution is finally here. And women are leading it. The Story Exchange https://thestoryexchange.org/sex-tech-revolution-finally-here-women-leading-it/ (2019).

  204. Dixon, E. How innovative design is reshaping the sex tech industry. CNN https://edition.cnn.com/style/article/sex-tech-design/index.html (2020).

  205. Kubes, T. New materialist perspectives on sex robots. A feminist dystopia/utopia? Soc. Sci. 8, 224 (2019).

    Google Scholar 

  206. Williams, D. J. et al. Introducing a multidisciplinary framework of positive sexuality. J. Posit. Sexuality 1, 6–11 (2015).

    Google Scholar 

  207. Louisa, A. Pleasure’s perils? Critically reflecting on pleasure’s inclusion in sexuality education. Sexualities 15, 455–471 (2012).

    Google Scholar 

  208. Wood, R., Hirst, J., Wilson, L. & Burns-O’Connell, G. The pleasure imperative? Reflecting on sexual pleasure’s inclusion in sex education and sexual health. Sex. Educ. 19, 1–14 (2019).

    Google Scholar 

  209. Ventus, D. et al. Vibrator-assisted start–stop exercises improve premature ejaculation symptoms: a randomized controlled trial. Arch. Sex. Behav. 49, 1559–1573 (2020).

    PubMed  Google Scholar 

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Glossary

Sexual script

Sexual scripting suggests the importance of meanings and symbols in human sexuality. A script can be layered through three dimensions: cultural scenarios, interpersonal scenarios and intrapsychic scenarios. A sexual sensation does not simply emerge from bodily reactions, but needs to be assigned meanings and symbols that provide cues and clues to enable sexualities to develop. Sexual scripts are blueprints and guidelines for what we define as our role in sexual expression, sexual orientation, sexual behaviours, sexual desires and the sexual component of our self-definition.

Self-actualization

The highest level of psychological development, whereby a person’s potential is fully realized after basic bodily and ego needs have been fulfilled. People are able to accept themselves and others as they are.

Rape myths

First described by M. Burt in 1980, rape myths are prejudiced, stereotyped and false assumptions about sexual attacks, rapists and rape victims. Rape myths are often used to excuse sexual assault, foster animosity toward victims and distort criminal justice.

Feminist discourses

A wide range of analytical work in psychology from a feminist perspective. It constitutes a thorough critical evaluation of intellectual, social and political changes that are needed to promote female rights.

Male gaze

Suggests a sexualized way of looking that empowers men and objectifies women. The woman is visually positioned as an object of heterosexual male desire.

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Dewitte, M., Reisman, Y. Clinical use and implications of sexual devices and sexually explicit media. Nat Rev Urol 18, 359–377 (2021). https://doi.org/10.1038/s41585-021-00456-2

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