Cunnilingus
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Cunnilingus is an
oral sex Oral sex, sometimes referred to as oral intercourse, is sexual activity involving the stimulation of the genitalia of a person by another person using the mouth (including the lips, tongue, or teeth) and the throat. Cunnilingus is oral sex p ...
act performed by a person on the
vulva The vulva (plural: vulvas or vulvae; derived from Latin for wrapper or covering) consists of the external female sex organs. The vulva includes the mons pubis (or mons veneris), labia majora, labia minora, clitoris, vestibular bulbs, vulv ...
or
vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...
of another person. The
clitoris The clitoris ( or ) is a female sex organ present in mammals, ostriches and a limited number of other animals. In humans, the visible portion – the glans – is at the front junction of the labia minora (inner lips), above the op ...
is the most sexually sensitive part of the human female genitalia, and its stimulation may result in a woman becoming sexually aroused or achieving
orgasm Orgasm (from Greek , ; "excitement, swelling") or sexual climax is the sudden discharge of accumulated sexual excitement during the sexual response cycle, resulting in rhythmic, involuntary muscular contractions in the pelvic region chara ...
. Cunnilingus can be sexually arousing for participants and may be performed by a
sexual partner Sexual partners are people who engage in sexual activity together. The sexual partners may be in a committed relationship, either on an exclusive basis or not, or engage in the sexual activity on a casual basis. They may be on intimate terms ...
as foreplay to incite sexual arousal before other
sexual activities Human sexual activity, human sexual practice or human sexual behaviour is the manner in which humans experience and express their sexuality. People engage in a variety of sexual acts, ranging from activities done alone (e.g., masturbation) t ...
(such as
vaginal In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen. ...
or anal intercourse) or as an
erotic Eroticism () is a quality that causes sexual feelings, as well as a philosophical contemplation concerning the aesthetics of sexual desire, sensuality, and romantic love. That quality may be found in any form of artwork, including painting, scu ...
and physically intimate act on its own. Cunnilingus can be a risk for contracting
sexually transmitted infections Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are spread by sexual activity, especially vaginal intercourse, anal sex, and oral ...
(STIs), but the transmission risk for oral sex, especially HIV transmission, is significantly lower than for vaginal or anal sex. Oral sex is often regarded as
taboo A taboo or tabu is a social group's ban, prohibition, or avoidance of something (usually an utterance or behavior) based on the group's sense that it is excessively repulsive, sacred, or allowed only for certain persons.''Encyclopædia Britannica ...
, but most countries do not have laws which ban the practice. Commonly, heterosexual couples do not regard cunnilingus as affecting the
virginity Virginity is the state of a person who has never engaged in sexual intercourse. The term ''virgin'' originally only referred to sexually inexperienced women, but has evolved to encompass a range of definitions, as found in traditional, modern ...
of either partner, while
lesbian A lesbian is a Homosexuality, homosexual woman.Zimmerman, p. 453. The word is also used for women in relation to their sexual identity or sexual behavior, regardless of sexual orientation, or as an adjective to characterize or associate n ...
couples commonly do regard it as a form of virginity loss.Se
pages 11
an
47-49
for male virginity, how gay and lesbian individuals define virginity loss, and for how the majority of researchers and heterosexuals define virginity loss/"technical virginity" by whether or not a person has engaged in vaginal sex.
People may also have negative feelings or
sexual inhibition A sexual inhibition is a conscious or subconscious constraint or curtailment by a person of behavior relating to specific sexual matters or practices, a discussion of sexual matters or viewing certain sexual material. To some extent such inhibit ...
s about giving or receiving cunnilingus or may refuse to engage in it.


Etymology and terminology

The term ''cunnilingus'' is derived from the
Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through ...
words for the
vulva The vulva (plural: vulvas or vulvae; derived from Latin for wrapper or covering) consists of the external female sex organs. The vulva includes the mons pubis (or mons veneris), labia majora, labia minora, clitoris, vestibular bulbs, vulv ...
(''
cunnus The vulva (plural: vulvas or vulvae; derived from Latin for wrapper or covering) consists of the external female sex organs. The vulva includes the mons pubis (or mons veneris), labia majora, labia minora, clitoris, vestibular bulbs, vulval ...
'') and the verb "to lick" ('' lingō''). There are numerous slang terms for cunnilingus, including "drinking from the furry cup", "carpet munching", and " muff-diving". Additional common slang terms used are "giving lip", "
lip service Lip service may refer to: Idiom * Lip service, an idiom for insincere talk Film * ''Lip Service'' (1988 film), an American comedy TV film Television * ''Lip Service'' (TV series), a 2010 dramatic series broadcast on BBC Three * ''Lip Serv ...
", or " tipping the velvet"; this last is an expression that novelist Sarah Waters argues that she "plucked from the relative obscurity of Victorian porn". It is also popularly known in the urban community as "dining at the Y" or "DATY". A person who performs cunnilingus may be referred to as a "cunnilinguist".


Practice


General

General statistics indicate that 70–80% of women require direct clitoral stimulation to achieve orgasm. Shere Hite's research on
human female sexuality Human female sexuality encompasses a broad range of behaviors and processes, including female sexual identity and Human sexual activity, sexual behavior, the physiological, psychological, social, cultural, political, and spiritual or religious ...
reports that, for most women, orgasm is easily achieved by cunnilingus because of the direct clitoral stimulation (including stimulation to other external parts of the vulva that are physically related to the clitoris) that may be involved during the act. A person who performs cunnilingus on someone might be referred to as the giving partner, and the other person as the receiving partner. During the activity, the receiving female's partner may use fingers to open the
labia majora The labia majora (singular: ''labium majus'') are two prominent longitudinal cutaneous folds that extend downward and backward from the mons pubis to the perineum. Together with the labia minora they form the labia of the vulva. The labia maj ...
(genital lips) to enable the tongue to better stimulate the clitoris, or the female may separate the labia for her partner. Separating the legs wide would also usually open the vulva sufficiently for the partner to orally reach the clitoris. Some
sex manual Sex is the trait that determines whether a sexually reproducing animal or plant produces male or female gametes. Male plants and animals produce smaller mobile gametes (spermatozoa, sperm, pollen), while females produce larger ones ( ova, of ...
s recommend beginning with a gentler, less focused stimulation of the
labia The labia are part of the female genitalia; they are the major externally visible portions of the vulva. In humans, there are two pairs of labia: the ''labia majora'' (or the outer labia) are larger and thicker, while the '' labia minora'' are fo ...
and the whole genital area. The tip, blade, or underside of the tongue may be used, and so might the nose, chin, teeth and lips. Movements can be slow or fast, regular or erratic, firm or soft, according to the participants' preferences. The tongue can be inserted into the
vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...
, either stiffened or moving. The performing partner may also hum to produce vibration. Cunnilingus may be accompanied by fingering the vagina or anus, or by the use of a
sex toy A sex toy is an object or device that is primarily used to facilitate Human sexual activity, human sexual pleasure, such as a dildo, artificial vagina or Vibrator (sex toy), vibrator. Many popular sex toys are designed to resemble human genita ...
; for penetration of the vagina, the aim may be to stimulate an area that may be termed "the
G-spot The G-spot, also called the Gräfenberg spot (for German gynecologist Ernst Gräfenberg), is characterized as an erogenous area of the vagina that, when stimulated, may lead to strong sexual arousal, powerful orgasms and potential female ejacu ...
". Women may consider personal hygiene before practicing oral sex important, as poor hygiene can lead to odors, accumulation of sweat and micro-residue (such as lint, urine or menstrual blood), which the giving partner may find unpleasant. Some women remove or trim their pubic hair, which may enhance their oral sex experience. Autocunnilingus, which is cunnilingus performed by a female on herself, may be possible, but an unusually high degree of flexibility is required, which may be possessed only by
contortion Contortion (sometimes contortionism) is a performance art in which performers called contortionists showcase their skills of extreme physical flexibility. Contortion acts often accompany acrobatics, circus acts, street performers and other liv ...
ists.


Specific positions

Any position which offers a sex partner oral access to a female's crotch area is suitable for cunnilingus, including: *In the doggy style position, the woman may crouch on all fours while her partner performs oral sex on her from behind or from below. *While facesitting, the woman may sit on or above her partner's face. In this position, she has more control over her body movements and can guide her partner or auto-stimulate against the partner's face. *While lying on her back, the woman may spread her legs or pull them up to her chest, or place them on her partner's shoulders. She may lie on any surface, such as a table or floor. *Partners may engage in mutual stimulation via the
69 position Sixty-nine or 69, also known by its French name soixante-neuf (69), is a group of sex positions in which two people align themselves so that each person's mouth is near the other's genitals, each simultaneously performing oral sex on the other. ...
. *The woman may sit on a chair or use some other support. *During the spreadeagle position, the woman's arms and legs are spread wide. *The woman may stand while her partner is either sitting or on the knees. However, in this position the clitoris is more difficult to reach and stimulate orally. The woman may lean against a wall or hold onto furniture for support.


During menstruation

Cunnilingus may be performed during
menstruation Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of ...
, which may be called "to earn one's red wings" in slang. The phrase is a reference to menstrual blood stains in the shape of a small bird's wings that are liable to form on the giving partner's cheeks during the act. The red wing patch was common among the
Hells Angels The Hells Angels Motorcycle Club (HAMC) is a worldwide outlaw motorcycle club whose members typically ride Harley-Davidson motorcycles. In the United States and Canada, the Hells Angels are incorporated as the Hells Angels Motorcycle Corporati ...
by the mid-1960s, and the slang term continued to be known among biker gangs in the 1980s.
North Carolina Reports: Cases Argued and Determined in the Supreme Court of North Carolina
'', volume 304. Published by Edwards & Broughton, in 1981. P.454.
Gershon Legman Gershon Legman (November 2, 1917 – February 23, 1999) was an American cultural critic and folklorist, best known for his books ''The Rationale of the Dirty Joke'' (1968) and ''The Horn Book: Studies in Erotic Folklore and Bibliography'' (1 ...
saw the act/badge not only as functioning a homosocial tie, but also as reflecting a deep and primitive belief in the lifegiving powers of blood. The elder Mirabeau, in his ''Erotika Biblion'' of 1783, saw cunnilingus during menstruation as an extreme act, linked with the submissive worship of the
Mother goddess A mother goddess is a goddess who represents a personified deification of motherhood, fertility goddess, fertility, creation, destruction, or the earth goddess who embodies the bounty of the earth or nature. When equated with the earth or t ...
, and by extension to the Black Mass.


Health aspects


Sexually transmitted infections

Chlamydia Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium '' Chlamydia trachomatis''. Most people who are infected have no symptoms. When symptoms do appear they may occur only several we ...
,
human papillomavirus Human papillomavirus infection (HPV infection) is caused by a DNA virus from the '' Papillomaviridae'' family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and r ...
(HPV),
gonorrhea Gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium ''Neisseria gonorrhoeae''. Infection may involve the genitals, mouth, or rectum. Infected men may experience pain or burning with u ...
,
syphilis Syphilis () is a sexually transmitted infection caused by the bacterium '' Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, a ...
,
herpes Herpes simplex is a viral infection caused by the herpes simplex virus. Infections are categorized based on the part of the body infected. Oral herpes involves the face or mouth. It may result in small blisters in groups often called cold ...
,
hepatitis Hepatitis is inflammation of the liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes ( jaundice), poor appetite, vomiting, tiredness, abdominal ...
(multiple strains), and other
sexually transmitted infections Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are spread by sexual activity, especially vaginal intercourse, anal sex, and oral ...
(STIs) can be transmitted through oral sex. Also se
Fact Sheet
Any sexual exchange of bodily fluids with a person infected with HIV, the virus that causes
AIDS Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual ma ...
, poses a risk of infection. Risk of STI infection, however, is generally considered significantly lower for oral sex than for
vaginal In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen. ...
or
anal sex Anal sex or anal intercourse is generally the insertion and thrusting of the erect penis into a person's anus, or anus and rectum, for sexual pleasure.Sepages 270–271for anal sex information, anpage 118for information about the clitoris. ...
, with HIV transmission considered the lowest risk with regard to oral sex. Furthermore, the documented risk of HIV transmission through cunnilingus is lower than that associated with
fellatio Fellatio (also known as fellation, and in slang as blowjob, BJ, giving head, or sucking off) is an oral sex act involving a person stimulating the penis of another person by using the mouth, throat, or both. Oral stimulation of the scrotu ...
, vaginal or anal intercourse. There is an increased risk of STI if the receiving partner has wounds on her genitals, or if the giving partner has wounds or open sores on or in his or her mouth, or bleeding gums. Brushing the teeth, flossing, or undergoing dental work soon before or after performing cunnilingus can also increase the risk of transmission, because all of these activities can cause small scratches in the lining of the mouth. These wounds, even when they are
microscopic The microscopic scale () is the scale of objects and events smaller than those that can easily be seen by the naked eye, requiring a lens or microscope to see them clearly. In physics, the microscopic scale is sometimes regarded as the scale be ...
, increase the chances of contracting STIs that can be transmitted orally under these conditions. Such contact can also lead to more mundane infections from common
bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were am ...
and
virus A virus is a submicroscopic infectious agent that replicates only inside the living cells of an organism. Viruses infect all life forms, from animals and plants to microorganisms, including bacteria and archaea. Since Dmitri Ivanovsk ...
es found in, around and secreted from the genital regions. Because of the aforementioned factors, medical sources advise the use of effective barrier methods when performing or receiving cunnilingus with a partner whose STI status is unknown. Cunnilingus during menstruation is considered high risk for the partner performing cunnilingus because there may be a high concentration of virus in menstrual blood, such as
hepatitis B Hepatitis B is an infectious disease caused by the '' Hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection. Many people have no symptoms during an initial infection. ...
.


HPV and oral cancer

Links have been reported between oral sex and
oral cancer Oral cancer, also known as mouth cancer, is cancer of the lining of the lips, mouth, or upper throat. In the mouth, it most commonly starts as a painless white patch, that thickens, develops red patches, an ulcer, and continues to grow. When on ...
with human papillomavirus (HPV)-infected people. A 2005 research study suggested that performing unprotected oral sex on a person infected with HPV might increase the risk of oral cancer. The study found that 36 percent of the cancer patients had HPV compared to only 1 percent of the healthy control group. A 2007 study found a
correlation In statistics, correlation or dependence is any statistical relationship, whether causal or not, between two random variables or bivariate data. Although in the broadest sense, "correlation" may indicate any type of association, in statistic ...
between oral sex and
throat cancer Head and neck cancer develops from tissues in the lip and oral cavity (mouth), larynx (throat), salivary glands, nose, sinuses or the skin of the face. The most common types of head and neck cancers occur in the lip, mouth, and larynx. Symptoms ...
. It is believed that this is due to the transmission of HPV, a virus that has been implicated in the majority of cervical cancers and which has been detected in throat cancer tissue in numerous studies. The study concludes that people who had one to five oral sex partners in their lifetime had approximately a doubled risk of throat cancer compared with those who never engaged in this activity, and those with more than five oral sex partners had a 250 percent increased risk.


Mechanical trauma to the tongue

The lingual frenulum (underside of the tongue) is vulnerable to
ulceration An ulcer is a discontinuity or break in a bodily membrane that impedes normal function of the affected organ. According to Robbins's pathology, "ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing o ...
by repeated friction during sexual activity (" cunnilingus tongue"). Ulceration of the lingual frenulum caused by cunnilingus is horizontal, the lesion corresponding to the contact of the under surface of the tongue with the edges of the lower front teeth when the tongue is in its most forward position. This type of lesion resolves in 7–10 days, but may recur with repeated performances. Chronic ulceration at this site can cause linear fibrous
hyperplasia Hyperplasia (from ancient Greek ὑπέρ ''huper'' 'over' + πλάσις ''plasis'' 'formation'), or hypergenesis, is an enlargement of an organ or tissue caused by an increase in the amount of organic tissue that results from cell proliferatio ...
. The incisal edges of the mandibular teeth can be smoothed to minimize the chance of trauma.


Cultural and religious views


General views

Cultural views on giving or receiving cunnilingus range from aversion to high regard. It has been considered
taboo A taboo or tabu is a social group's ban, prohibition, or avoidance of something (usually an utterance or behavior) based on the group's sense that it is excessively repulsive, sacred, or allowed only for certain persons.''Encyclopædia Britannica ...
, or discouraged, in many cultures and parts of the world. In Chinese
Taoism Taoism (, ) or Daoism () refers to either a school of philosophical thought (道家; ''daojia'') or to a religion (道教; ''daojiao''), both of which share ideas and concepts of Chinese origin and emphasize living in harmony with the '' Ta ...
, cunnilingus is revered as a spiritually-fulfilling practice that is believed to enhance
longevity The word " longevity" is sometimes used as a synonym for " life expectancy" in demography. However, the term ''longevity'' is sometimes meant to refer only to especially long-lived members of a population, whereas ''life expectancy'' is always ...
. In modern
Western culture Leonardo da Vinci's ''Vitruvian Man''. Based on the correlations of ideal Body proportions">human proportions with geometry described by the ancient Roman architect Vitruvius in Book III of his treatise ''De architectura''. image:Plato Pio-Cle ...
, oral sex is widely practiced among adolescents and adults. Laws of some jurisdictions regard cunnilingus as penetrative sex for the purposes of sexual offenses with regard to the act, but most countries do not have laws which ban the practice, in contrast to anal sex or
extramarital sex Extramarital sex occurs when a married person engages in sexual activity with someone other than their spouse. The term may be applied to the situation of a single person having sex with a married person. Where extramarital sexual relations do n ...
. People give various reasons for their dislike or reluctance to perform cunnilingus, or having cunnilingus performed on them. Some regard cunnilingus and other forms of oral sex as unnatural because the practices do not result in reproduction. Some cultures attach symbolism to different parts of the body, leading some people to believe that cunnilingus is ritually unclean or humiliating. While commonly believed that
lesbian sexual practices Lesbian sexual practices are sexual activities involving women who have sex with women, regardless of their sexual orientation. A woman who has sex with another woman may identify as a lesbian if she is sexually attracted to women, or bisexual ...
involve cunnilingus for all women who have sex with women, some lesbian or bisexual women dislike cunnilingus due to not liking the experience or due to psychological or social factors, such as regarding it as unclean. Other lesbian or bisexual women believe that it is a necessity or largely defines lesbian sexual activity. Lesbian couples are more likely to consider a woman's dislike of cunnilingus as a problem than heterosexual couples are, and it is common for them to seek therapy to overcome inhibitions regarding it. Oral sex is also commonly used as a means of preserving
virginity Virginity is the state of a person who has never engaged in sexual intercourse. The term ''virgin'' originally only referred to sexually inexperienced women, but has evolved to encompass a range of definitions, as found in traditional, modern ...
, especially among heterosexual pairings; this is sometimes termed ''
technical virginity Virginity is the state of a person who has never engaged in sexual intercourse. The term ''virgin'' originally only referred to sexually inexperienced women, but has evolved to encompass a range of definitions, as found in traditional, modern ...
'' (which additionally includes anal sex,
mutual masturbation Non-penetrative sex or outercourse is sexual activity that usually does not include sexual penetration. It generally excludes the penetrative aspects of vaginal, anal, or oral sexual activity, but includes various forms of sexual and non-sex ...
and other non-penetrative sex acts, but excludes penile-vaginal sex). The concept of "technical virginity" or
sexual abstinence Sexual abstinence or sexual restraint is the practice of refraining from some or all aspects of sexual activity for medical, psychological, legal, social, financial, philosophical, moral, or religious reasons. Sexual abstinence is distinct from ...
through oral sex is particularly popular among teenagers. By contrast, lesbian pairings commonly consider oral sex or fingering as resulting in virginity loss, though definitions of virginity loss vary among lesbians as well.


Taoism

Cunnilingus is accorded a revered place in
Taoism Taoism (, ) or Daoism () refers to either a school of philosophical thought (道家; ''daojia'') or to a religion (道教; ''daojiao''), both of which share ideas and concepts of Chinese origin and emphasize living in harmony with the '' Ta ...
. This is because the practice was believed to achieve longevity, by preventing the loss of semen, vaginal and other bodily liquids, whose loss is believed to bring about a corresponding loss of vitality. Conversely, by either semen retention or ingesting the secretions from the vagina, a person can conserve and increase their '' ch'i,'' or original vital breath. According to Philip Rawson (in Paz, p. 97), these half-poetic, half-medicinal metaphors explain the popularity of cunnilingus among people: "The practice was an excellent method of imbibing the precious feminine fluid" (Paz, p. 97). But the Taoist ideal is not just about the male's being enriched by female secretions; the female also benefits from her communion with the male, a feature that has led
sinologist Sinology, or Chinese studies, is an academic discipline that focuses on the study of China primarily through Chinese philosophy, language, literature, culture and history and often refers to Western scholarship. Its origin "may be traced to the ex ...
Kristofer Schipper to denounce the ancient handbooks on the "Art of the Bedroom" as embracing a "kind of glorified male vampirism" that is not truly Taoist at all. Kristofer Schipper. 9821993. ''The Taoist Body''. trans. Karen C. Duval. Berkeley; Los Angeles; (London: University of California Press). p. 148


See also

*
Anilingus Anilingus (from the Latin ''anus'' + ''-lingus'', from ''lingere'', "to lick", variantly spelled "analingus") is the oral and anal sex act in which a person stimulates the anus of another by using the mouth, including lips, tongue, or teeth. I ...
* Facesitting *
Fellatio Fellatio (also known as fellation, and in slang as blowjob, BJ, giving head, or sucking off) is an oral sex act involving a person stimulating the penis of another person by using the mouth, throat, or both. Oral stimulation of the scrotu ...


References


Further reading

*
Gershon Legman Gershon Legman (November 2, 1917 – February 23, 1999) was an American cultural critic and folklorist, best known for his books ''The Rationale of the Dirty Joke'' (1968) and ''The Horn Book: Studies in Erotic Folklore and Bibliography'' (1 ...
: ''The Guilt of the Templars''. Basic Books Inc., New York, 1966. * Gershon Legman: '' Rationale of the Dirty Joke: An Analysis of Sexual Humor'',
Simon & Schuster Simon & Schuster () is an American publishing company and a subsidiary of Paramount Global. It was founded in New York City on January 2, 1924 by Richard L. Simon and M. Lincoln Schuster. As of 2016, Simon & Schuster was the third largest publi ...
, 1968. {{Human sexuality Non-penetrative sex Oral eroticism Sex positions Sexual acts Vulva