A Clinical Reference Guide on Sexual Devices

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In the United States, more than half of all women have used a vibrator, nearly one-third of women have used a dildo, and more than three-quarters of women who have sex with women have used a vibrator. Sexual devices can be used by patients with decreased libido, anorgasmia, conditions inhibiting vaginal penetration, partner erectile dysfunction, and motor or sensory disabilities. Basic knowledge of sexual devices can help obstetrician-gynecologists counsel patients about device safety, sharing, cleaning, disinfection, and material selection. Common sexual devices include vibrators, penetrative devices, anal-specific devices, and air pulsation devices. Collision dyspareunia aids can assist patients who experience difficulty with deep penetration owing to pain and structural limitations. Although rare, the most common risks of sexual devices are traumatic injury and infection. Barrier use over sexual devices and proper disinfection can help reduce, but not eliminate, the risk of transmission of common viral and bacterial sexually transmitted infections. Sexual devices made of nonporous materials are the safest and easiest to clean and disinfect. Porous materials should be avoided given the inability to disinfect and risk of material breakdown. Sexual devices can benefit specific patient populations, including women who are pregnant or postpartum, those with disorders of sexual function or pelvic floor, menopausal patients, cancer patients undergoing treatment, and women with disabilities and chronic illness.




Sexual devices, including vibrators, dildos, and other products designed to aid in sexual activity, are becoming increasingly integrated into patients’ overall sexual experiences.1
More than half of all women in the United States have used a vibrator and nearly one-third of women have used a dildo.2 Prevalence of use is even higher in women who have sex with women, with more than 75% of women who have sex with women reporting vibrator use.3 Patients may use sexual enhancement devices during masturbation or partnered sexual activity to increase arousal, increase the likelihood of orgasm, decrease latency time to orgasm, or enhance their sexual life in other ways.4,5 The same devices may also be used as sexual therapeutic devices for patients with decreased libido, anorgasmia, conditions inhibiting vaginal penetration, partner erectile dysfunction, and motor or sensory disabilities.6

Increased knowledge surrounding sexual device use can assist obstetrician-gynecologists (ob-gyns) in screening for sexually transmitted infection (STI), making recommendations to patients who may benefit from sexual aids, and counseling regarding noncoital sexual activity safety.
The adult product industry is an unregulated consumer market; therefore, understanding the safety profile of various products is central to patient counseling. Some clinicians may be uncomfortable discussing sexual devices with patients given the pervasive taboo regarding their use and their association with masturbation, erectile dysfunction, and sexual paraphilia, or because of perceived irrelevance and diffusion of responsibility to other medical specialties. However, ob-gyns are uniquely positioned to discuss intimate details of patients’ lives, and thus a basic knowledge of sexual devices is fundamental to providing comprehensive sexual healthcare uniquely positioned to discuss intimate details of patients’ lives, and thus a basic knowledge of sexual devices is fundamental to providing comprehensive sexual healthcare.

*The American College of Obstetricians and Gynecologists recommends that providers discuss sexual device cleaning with patients to reduce the risk of associated infection.7 Similarly, leading experts in the field of sexual medicine have advocated for increased discussion of sexual device use.8 The purpose of this article is to educate ob-gyns about sexual devices and to serve as a clinical reference guide.





TERMINOLOGY

Sexual device refers to any object designed to physically aid in sexual arousal, activity, or stimulation. These devices may be used for sexual enhancement, as well as for medical therapeutic purposes—specifically pelvic floor rehabilitation or to facilitate otherwise difficult sexual activity in patients with medical conditions or disabilities. Thus, sexual devices can be separated into two broad categories of sexual enhancement and sexual therapeutic use. All sexual devices have similar mechanisms of action in that they provide stimulation to the clitoris, vagina, rectum, or other erogenous zones, either with vibration, pulsation, pressure, or penetration, to enhance, accelerate, or prolong any phases of the sexual response cycle.

A variety of terminology is used in the medical literature and in the lay press to refer to sexual devices. In addition to the colloquially used term “sex toy,” practitioners may encounter “lifestyle product,” “marital aid,” and “adult novelty products,” among others.
Although “sexual aid” may have different definitions within urology, gynecology, and sexual medicine literature, patients with sexual disorders may find this term more sensitively addressing the degree of disability associated with their conditions. Some patients with disabilities or those in the lesbian, gay, bisexual, transgender, queer, and intersex community, however, may find the term sexual aid is negative and implies that their baseline sexual activity is insufficient or dysfunctional. For these patients, as well as anyone using devices for purely recreational sexual enhancement, the term “sexual device” may be more appropriate. Box 1 defines additional terms used in this guide.



*SCREENING AND COUNSELING

*TYPES OF SEXUAL DEVICES

-Vibrators
-Penetrative Devices (Dildos)
-Anal-Specific Devices
-Air Pulsation Devices
-Collision Dyspareunia Aids


*MATERIALS
-Nonporous Materials
-Porous Materials


*SAFETY
-Traumatic Injury
-Infection
-Barriers and Personal Lubricants


*CLEANING AND DISINFECTION

*SPECIFIC PATIENT POPULATIONS

-Pregnancy and Postpartum
-Disorders of Sexual Function
-Pelvic Floor Dysfunction
-Menopause
-Oncology
-Disability and Chronic Illness
-Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual Patients
-Adolescents


*PURCHASING




CONCLUSION


Knowledge about sexual devices is important for obstetrics and gynecology clinicians to help educate patients regarding use, counsel about cleaning and disinfection, and assist in safe material and product selection. Discussions about a patient’s sexual wellness may also engender provider trust and facilitate rapport. Screening for sexual device use is an important aspect of preventative women’s health, given the adverse consequences of improper use, handling, and hygiene. In certain patient populations, sexual devices can be beneficial for sexual health.
 

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Fig. 1. Four types of vibrators. A. Wand, B. bullet, C. dual stimulation, D. wearable. Illustration by Jonathan R. Matusky. Used with permission. Rubin. Sexual Devices: A Clinical Reference Guide. Obstet Gynecol 2019.
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Fig. 2. Dildo. Illustration by Jonathan R. Matusky. Used with permission. Rubin. Sexual Devices: A Clinical Reference Guide. Obstet Gynecol 2019.

Fig. 4. Strap-on harness. Illustration by Jonathan R. Matusky. Used with permission. Rubin. Sexual Devices: A Clinical Reference Guide. Obstet Gynecol 2019
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Fig. 3. Double-sided dildo. Illustration by Jonathan R. Matusky. Used with permission. Rubin. Sexual Devices: A Clinical Reference Guide. Obstet Gynecol 2019.
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Fig. 5. Anal plug. Illustration by Jonathan R. Matusky. Used with permission. Rubin. Sexual Devices: A Clinical Reference Guide. Obstet Gynecol 2019.
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Fig. 6. Air pulsation device. Illustration by Jonathan R. Matusky. Used with permission. Rubin. Sexual Devices: A Clinical Reference Guide. Obstet Gynecol 2019
Screenshot (9008).png
 
Fig. 7. Collision dyspareunia device. Illustration by Jonathan R. Matusky. Used with permission. Rubin. Sexual Devices: A Clinical Reference Guide. Obstet Gynecol 2019.
Screenshot (9009).png
 
Box 1. Definitions

*Sexual device: any object designed to physically aid in sexual arousal, activity, or stimulation

*Sex toy: a common colloquial term for a sexual device. Often refers to devices when used for purely recreational sexual enhancement

*Vibrator (Fig. 1): a device using an electric motor to create the vibration for external or internal genital stimulation

*Dildo (Fig. 2): a phallus-shaped device designed for vaginal or rectal penetration or stimulation. Can be combined with a harness. Dildos with two insertive ends for partner use are called “double-sided dildos” (Fig. 3)

*Strap-on: a harness (Fig. 4) and dildo used in combination to facilitate hands-free sexual activity

*Anal plug (Fig. 5): wedge-shaped device with a wide protective flange designed to be placed in the rectum and remain there for the duration of sexual activity

*Air pulsation device (Fig. 6): a device using mild air pulsations directly to the clitoris


*Collision dyspareunia aid (Fig. 7): a protective donut-shaped bumper that rests around the base of a penis or dildo to prevent deep penetration
 
Box 2. Examples of Sexual Device Screening Questions

1. Have you ever or do you currently use a sexual device, such as a vibrator or dildo, alone or with a partner?

2. Would you consider using a sexual device if it would improve your sexual health and wellness?


If “yes” to 1, consider the following questions:

3. Do you use your device externally (around the vulva or clitoris) or internally (in the vagina)?

4. Do you use your device inside or near the rectum or anus?

5. Do you ever share devices with others?

6. What material is your device made from?

7. How often do you clean your device and by what method, if at all?
 
Box 3. Examples of Vibrators

*Wand: vibrators with a soft, tennis-ball-sized head that vibrates and contains a large plastic handle for the motor

*Bullet: thumb-sized, battery-powered vibrators intended for external use

*Dual-stimulation: vibrators meant to simultaneously stimulate the internal and external genitalia

*Wearable: vibrators designed to maintain external placement and stimulation during sexual activity, including vaginal penetration, either using leg straps or internal portion using pelvic floor muscles
 
Box 4. Disabilities and Chronic Conditions Whose Patient Populations May Benefit From Sexual Device Use

*Multiple sclerosis

*Diabetic peripheral neuropathy

*Cerebral palsy

*Spinal cord lesion or injury

*Parkinson’s disease

*Spina bifida

*Peripheral vascular disease

*Paraplegia

*Arthritis


*Depression
 
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