Only about 20% of university students participating in a 2007 survey agreed that oral-genital contact constituted sex, yet the majority believed that penile-vaginal and penile-anal intercourse did (98% and 78%, respectively), according to "Sex Redefined: The Reclassification of Oral-Genital Contact," by Jason D. Hans et al. The article is currently available online, and will appear in the June 2010 issue of Perspectives on Sexual and Reproductive Health. Participants in the survey were only about half as likely as those in a similar 1991 study to classify oral-genital contact as sex, suggesting that young people’s notions of what behaviors constitute sex have changed as oral sex has becoming increasingly acceptable among youth as a less-risky alternative to intercourse.

Participants’ views of what constitutes sex were assessed with the question "Would you say you ‘had sex’ with someone if the most intimate behavior you engaged in was" each of 11 behaviors. Respondents were unambiguous in their characterization of oral-genital contact: Only 20% would classify this activity as sex.

The authors suggest that school-based sex education programs and popular media, as well the infamous Clinton-Lewinsky incident, may have contributed to the changing conceptualization of oral-genital contact. They believe that the shift in thinking about what constitutes sex may be at least partly due to a surging emphasis on abstinence-only education, but also to comprehensive sex education programs’ primary focus on penile-vaginal intercourse. While this emphasis on intercourse at the expense of oral-genital contact may be justified if these programs’ primary objectives are to reduce the incidence of unplanned pregnancy and STDs, it discounts the risk of STD transmission resulting from oral-genital contact.

As the authors note, herpes, syphilis, gonorrhea, human papillomavirus, intestinal parasites, hepatitis A and HIV can be transmitted through oral-genital contact, although the risk associated with intercourse is much greater. And despite this risk, use of condoms and dental dams with oral sex is rare. As oral-genital stimulation becomes increasingly disassociated from sex and instead thought of as "messing around," the authors speculate that people who engage in this behavior will become increasingly unmindful of the health risks. They suggest that sex education programs can help minimize the risk by giving increased attention to the role of oral-genital stimulation in STD transmission and the appropriate preventive measures that can be taken.