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CONTEXT: Although partially anecdotal, some evidence suggests that oral-genital contact is increasingly excluded from young people's notions of what behaviors constitute sex. Such a shift may have implications for STD prevention.

METHODS: In 2007, a convenience sample of 477 university students participated in a survey that included the question “Would you say you ‘had sex’ with someone if the most intimate behavior you engaged in was” each of 11 behaviors. Chi-square tests and independent samples t tests were used to assess gender differences, and chi-square analyses were used to compare the data with similar data collected in 1991. Predictors of beliefs concerning the classification of oral-genital contact were assessed using logistic regression analysis.

RESULTS: The majority of respondents indicated that penile-vaginal intercourse and penile-anal intercourse constitute sex (98% and 78%, respectively), but only about 20% believed the same was true of oral-genital contact. The proportion classifying oral-genital contact as sex in 2007 was about half that in 1991. This difference was consistent for both sexes and for both giving and receiving oral-genital stimulation. Responses did not vary by respondents’ sexual experience or demographic characteristics.

CONCLUSIONS: Sociocultural conceptualizations of oral-genital contact have shifted in a way that may leave people who engage in this activity unmindful of its potential health risks. Sex education programs, which generally focus on penile-vaginal contact, could help STD prevention efforts by explaining the risks associated with oral-genital stimulation and the measures that can be taken to minimize those risks.