March 8, 2010 -- Paging Dr. Ruth: Adults don't even agree on what it means to "have sex."
Researchers at the renowned Kinsey Institute at Indiana University asked 484 people "Would you say you had sex with someone if …"
People between the ages of 18 and 96 took part in the study, and their results showed no single generation or gender agrees on a definition of "had sex" -- be it oral, anal or digital.
But doctors, sociologists and therapists all agree that the varying definition of "sex" can be a big problem in some cases.
"Having sex is a euphemism. It is not a very exact term," said Eli Coleman, of the Program in Human Sexuality at the University of Minnesota Medical School in Minneapolis. "That's why it's very important that physicians and health care workers ask more specific and precise questions rather than using euphemisms."
Nearly 95 percent of people in the study agreed that penile-vaginal intercourse meant "had sex." But the numbers changed as the questions got more specific.
For example, 11 percent of respondents would not use the phrase "had sex" if "the man did not come." About 80 percent of respondents said penile-anal intercourse meant "had sex."
About 70 percent of people believed oral sex was sex.
"The only things we see consistently are the inconsistencies," said Brandon J. Hill, Kinsey Institute researcher and corresponding author on the recent study published in the journal Sexual Health.
Researchers at the Kinsey Institute first examined the question of what "had sex" meant to people in 1991, among college students at Indiana University. They asked nearly 600 students about various scenarios of sexual behavior, and 59 percent of respondents said that oral sex did not constitute having "had sex" with a partner.
Stephanie A. Sanders, who is also an author of the current study, and June M. Reinisch, director emeritus of the Kinsey Institute, published the student survey research eight years later -- shortly after the 1999 scandal between former President Clinton and White House intern Monica Lewinsky.
Research to Define 'Sex' Stirred Controversy
The decision to publicize the work at that time cost Dr. George D. Lundberg, the editor of the Journal of the American Medical Association, his job.
Hill said the most recent study gave researchers the chance to compare answers across age groups, and a few interesting differences appeared.
For example, 81 percent of all survey participants considered penile-anal intercourse as having had sex, but only 50 percent of men age 65 and up agreed.
"I don't think people were looking at other people [for the answers]," Hill said. "I think the definition definitely ran through their own experience."
By Hill's estimation, different ideas about what sex means may have less to do with a generational gap and upbringing, and more to do with forming the idea of "sex" into something that makes people feel good about themselves at the moment.
For instance, Hill hypothesized that "younger male participants may want to increase or decrease the number of partners at any given point so that would change the way they define sex."
If a person felt nervous in front of a doctor who was asking about the number of sex partners, that person may exclude oral sex to decrease the number, Hill said. On the other hand, if there was a bragging atmosphere, a person might extend the parameters of "having sex" to increase that number.
Reinisch, who is now director of Acquisitions and New Exhibitions at the Museum of Sex in New York City, pointed out that the older men in the study were unlikely to label penile-vaginal intercourse as "sex" if they were using a condom. One hundred percent of the men in the 18 to 29 age group called penile-vaginal intercourse with a condom sex, but only 82 percent of the men in the 65 and up age group considered sex with a condom sex.
Reinisch said this "reflects how a significant portion of individuals born during a certain era feel about or understand a particular phenomenon."
Why Different Ideas About 'Sex' Could Cause Problems
People who came of age before the contraceptive pill was widely available may then define intercourse as sex only if there's a possibility to procreate.
"Perhaps for older men what really counts ... is the act that is involved with procreation. The act that was primarily thought of and discussed as 'the sex act,'" Reinisch said.
Ed Laumann, a professor of sociology at the University of Chicago, said these differences require social science researchers to be really careful about asking questions in studies.
"It's been a discussed problem for a long time," said Laumann, who also doesn't believe we will ever come to a consensus as a society about what it means to have sex.
"Well, what is the answer? There is no true objective thing here," he said.
While changing definitions might be interesting for sociologists, the shifting definitions could cause doctors problems.
Coleman, of the University of Minneapolis' Program in Human Sexuality, said, "What kind of sexual activities a person is having will determine what kinds tests and where to test them."