Non-penetrative sex

Drawing by Franz von Bayros showing an act of fingering

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-sexual activity, such as frottage, mutual masturbation, kissing, or cuddling.^[1][2][3] Some forms of non-penetrative sex, particularly when termed outercourse, include penetrative aspects, such as penetration that may result from forms of fingering or oral sex.^[4][5][6]

People engage in non-penetrative sex for a variety of reasons, including as a form of foreplay or as a primary or preferred sexual act.^[2][7] Heterosexual couples may engage in non-penetrative sex as an alternative to penile-vaginal penetration, to preserve virginity, or as a type of birth control.^[7][8] Same-sex couples may also engage in non-penetrative sex to preserve virginity,^[7][9][10] with gay males using it as an alternative to anal penetration.^[7][9]

Although sexually transmitted infections (STIs/STDs) such as herpes, HPV, and pubic lice can be transmitted through non-penetrative genital-genital or genital-body sexual activity, non-penetrative sex may be used as a form of safer sex because it is less likely that body fluids (the main source of STI/STD transmission) will be exchanged during the activities, especially with regard to aspects that are exclusively non-penetrative.^[11][12][13]

Definitions and practices

General

While non-penetrative sex (or outercourse) is usually defined as excluding sexual penetration,^[1][2][3] some non-penetrative sex acts can have penetrative components and may therefore be categorized as non-penetrative sex. Oral sex, for example, which can include oral caress of the genitalia, as well as penile penetration of the mouth or oral penetration of the vagina, may be categorized as non-penetrative sex.^[4][5] Oral sex may also be considered outercourse solely because it is not vaginal or anal intercourse.^[14][15]

The words penetration and penetrative may be restricted to penile-vaginal penetration, and, in this way, the definition of outercourse additionally includes penetrative anal sex, with the term outercourse used to contrast the term sexual intercourse as vaginal sex.^[6][16][17] Definitions restricting the terms non-penetrative sex and outercourse to whether penile penetration has occurred,^[2][18] or to non-penetrative sexual acts that do not involve exchanges of potentially infectious body fluids,^[4][11] also exist.

The term heavy petting covers a broad range of foreplay activities, typically involving some genital stimulation, but not the direct act of penetrative sexual intercourse.^[19]

Frottage

Frot: two men rubbing their penises together to create sexual sensations

Frottage is the general term for the act of rubbing any part of the body, including the buttocks, the breasts, abdomen, thighs, feet, hands, legs and sexual organs against the sexual organ of another person; this is done whether naked or clothed and is more commonly known as dry humping or dry sex.^[20] When frottage includes genital-genital rubbing, it is sometimes called genito-genital or GG rubbing.^[20]

Couples may engage in frottage as a form of foreplay or simply as a method to achieve sexual gratification without the penetrative aspects of vaginal, anal or oral sex, which may also be their personal way of preserving virginity^[7][8] or their way of practicing safer sex.^[11] Often, young people will engage in frottage as an earlier stage of sexual intimacy before their idea of more explicit sexual contact is desired.

Other terms associated with frottage are:

• Princeton rub, Ivy League rub, and so on are slang terms referring to male-male frot or intercrural sex or both, presumably surviving from the days when these colleges only admitted men.^[21] W. H. Auden was proud of having been the first person to use the terms Princeton rub and Princeton first-year in print.^[22]
• The term frottage derives from the French verb frotter (i.e., to rub). Three terms derive from frotter. These include frottage, the sexual act involving rubbing; frot, the sexual act that refers exclusively to male-male genital rubbing without penetration (but may also be referred to as frottage);^[21][23] and frotteurism, a paraphilia involving obsession with frottage or performing frottage non-consensually (e.g., pressing one's genitals against a stranger on a crowded subway); this was once called "frottage," but the usage is no longer acceptable.^[24]

Mutual masturbation

1840 Johann Nepomuk Geiger depiction of mutual masturbation

Mutual masturbation (also called manual intercourse) usually involves the manual stimulation of genitals by two or more people who stimulate themselves or one another.^[25][26] This may be done in situations where the participants do not feel ready, physically able, socially at liberty, or willing to engage in any penetrative sex act, or a particular penetrative sex act, but still wish to engage in a mutual sexual activity. It is also done as part of a full repertoire of sexual activity, where it may be used as foreplay,^[26] while, for others, it is the primary sexual activity of choice.

Types of mutual masturbation include the handjob (the manual sexual stimulation of the penis or scrotum by a person on a male)^[27] and fingering (the manual sexual stimulation of the vagina, clitoris or other parts of the vulva, by a person on a female). Sexual stimulation of the genitals by using the feet may also be included, and so may manual stimulation of the anus.^[28]

Like frottage in general, mutual masturbation may be used as an alternative to penile-vaginal penetration, to preserve virginity or to prevent pregnancy.^[7][8] It might result in one or more of the partners achieving orgasm. If no bodily fluids are exchanged (as is common), mutual masturbation is a form of safe sex, and greatly reduces the risk of transmission of sexual diseases.^[11][12][13]

In partnered manual genital stroking to reach orgasm or expanded orgasm, both people focus on creating and experiencing an orgasm in one person. Typically, one person lies down pant-less, while his or her partner sits alongside. The partner who is sitting uses his or her hands and fingers (typically with a lubricant) to slowly stroke the penis or clitoris and other genitals of the partner. Expanded orgasm as a mutual masturbation technique reportedly creates orgasm experiences more intense and extensive than what can be described as, or included in the definition of, a regular orgasm.^[29] It includes a range of sensations that include orgasms that are full-bodied, and orgasms that last from a few minutes to many hours.^[30] However, this technique is not without risk of contracting sexually transmitted infections, in particular HIV. A person using his or her finger, with a small wound, to stimulate a woman's genitals could be infected with HIV found in her vagina's fluids; likewise regarding a man's semen containing HIV, which could infect a partner who has a small exposed wound on his or her skin.

Exclusively non-penetrative

Mammary intercourse, a form of non-penetrative sex between a man and a woman

Non-penetrative sex may sometimes be divided into acts that are exclusively non-penetrative and those that are not. Exclusively non-penetrative sexual acts include:

• Axillary intercourse: (slang: "bagpiping", in reference to the underarm manner in which bagpipes are played; directing traffic, or pit-wank, a variant of the term tit-wank, are also terms for axillary intercourse). It is a sexual variant where the penis is inserted in the other person's armpit.^[31][32][33]
• Bundling: a courtship tradition in some Christian communities that was opposed by the religious right and has largely died out. The two young people were each in a sack tied up at the neck, and put in a bed together for the night.
• Erotic massage: rubbing of the body to create pleasure and relaxation. This can be done between two or more people of any gender and sexual orientation. It can involve the use of oils (heated or otherwise) or just the individual's hands. It is also known as sensual massage.^[34][35]
• Footjob: sexually stimulating one individual's penis with another individual's feet. In some cases it can be part of a foot fetish. One individual places their feet around the penis and caresses it until orgasm is achieved. Variations where the clitoris is stimulated by feet also occur.^[36]
• Frot: act of genital-genital rubbing between males (especially penis-to-penis contact).
• Handjob: the manual sexual stimulation of the penis by a person on a male, often used as a form of mutual masturbation.
• Intercrural sex: when the penis is stimulated by placing it between another individual's thighs. Lubrication may be used to allow the penis to move more freely between the thighs.^[21][37][38]
• Intergluteal sex: stimulation of the penis using the buttocks, often used as a form of mutual masturbation. It differs from anal sex because no penetration of the anus occurs. The penis is stimulated by moving between the buttocks.^[39]
• Kissing: the touching of one person's lips against another person's can be regarded as a sexual act, especially deep kissing (French kissing) where one person inserts his tongue into the partner's mouth. Kissing may also be done on other parts of the body and is commonly a part of foreplay.^[40]
• Mammary intercourse: the stimulation of the penis by placing the penis between the breasts and moving the penis up and down to create pleasure.^[41]
• Stimulation of nipples: when one partner caresses (either manually or orally) the nipples of their partner. Any individual can participate in this act and it can be done in pairs or groups.^[42]
• Tribadism: a form of lesbian sex where females rub genitalia against each other (either rubbing genitalia together or rubbing one's genitalia against other parts of another individual's body).^[43][44]

Non-exclusively non-penetrative

• Fingering: stimulation of the vagina, vulva, clitoris in particular, or anus, with the fingers. It is often used as a form of mutual masturbation.
• Oral sex: stimulation of the genitals using the mouth and throat. It is known as fellatio when the act is performed on a penis, and cunnilingus when performed on female genitalia.^[45] A specific type of oral sex, anilingus, is the stimulation of the anus using the mouth.^[46]
• Stimulation using a vibrator: a partner or group of individuals may stimulate each other's genitals using a vibrator.^[47]

Hookup culture

In many developed countries, there is a trend where young individuals (typically late teens and early twenties) engage in casual sex, also known as a hookup. This phenomenon has been termed hookup culture. The term hookup in this context loosely means participating in some type of sexual activity (whether it is non-penetrative or penetrative) with another individual or group of individuals outside of a romantic relationship.^[48] Hooking up may be in the form of a one-night stand, where the sex acts are contained within a single situation or the individuals may "hook up" on a more consistent basis (sometimes known as being "friends with benefits"). In addition, hooking up can mean different things to different people. Some individuals believe a hookup is "anything but intercourse", which would include only non-penetrative sex acts.^[49] Birth control may not be utilized if the individuals are not planning on engaging in a sex act. Using birth control and ensuring all individuals present understand that the activity is a hookup with no other expectations can maximize benefits while minimizing risk.^[50] The benefits of sex acts are various, and if an individual is concerned about sexual infections or pregnancy, non-penetrative sex acts (which carry a significantly smaller risk than penetrative sex) can be sufficient in preventing the risks, and offer a wide variety of options to choose from.^[51]

Health risks

There is a sociocultural viewpoint that because non-penetrative sex usually does not involve a direct exchange of semen or vaginal fluids, and because at no point (in exclusively non-penetrative sex acts) does anything penetrate the vulva, vagina or anus, these acts are risk free. Although the risks associated with non-penetrative sex acts are significantly less than those associated with penetrative sex, there are still risks that can occur.^[11][12][13] There is a slight risk for pregnancy and sexually transmitted infections (STIs) with certain non-penetrative sex acts.^[52]

Pregnancy can still occur with anal sex or other forms of sexual activity where the penis is near the vagina (such as intercrural sex or other genital-genital rubbing) where sperm can be deposited near the entrance of the vagina and can travel along the vagina's lubricating fluids; the risk of pregnancy can also occur without the penis being near the vagina because sperm may be transported to the vaginal opening by the vagina coming in contact with fingers or other non-genital body parts that have come in contact with semen.^[53][54][55]

Like non-exclusive non-penetrative sex acts, STI transmission varies for exclusively non-penetrative sexual activities; some common STIs transmitted through exclusively non-penetrative sex acts, and how they are contracted, are the following:^[56]

• Herpes can be spread through kissing or anytime an infected mouth or genitals comes into contact with another individual's mouth or genitals (when it occurs on the genitals, it is known as genital herpes)
• Genital warts is similar to herpes, but caused by a different virus. It is also spread by skin-to-skin contact with the genitals
• Chancroid is spread through skin-to-skin contact when an infected individual has sores present and these sores come into contact with another individual (generally in the genital area)
• Cytomegalovirus (CMV) is spread through coming into contact with various body secretions (saliva, genital excretions, blood etc.)
• Human papillomavirus (HPV) is spread through skin-to-skin contact
• Molluscum contagiosum is spread through close contact with an infected person (sharing personal items or close skin-to-skin contact)
• Crab louse (also known as pubic lice or crabs) can be spread through close contact with an infected person
• Scabies is spread through close contact with an infected individual
• Syphilis can be spread through kissing, but is much more likely to be spread through vaginal, anal or oral intercourse
• Trichomoniasis (Trich) can be spread through sharing sex toys, during mutual masturbation or any time genital fluid are passed from one person to another

With regard to non-exclusive non-penetrative sex acts, the risks somewhat increase because there is penetration (either of the vagina, anus or mouth) and there is the potential for bodily fluids (semen, vaginal secretions, saliva) to be exchanged. In addition to the aforementioned STIs, the following can be transmitted through non-exclusive non-penetrative sex acts:^[57]

• Chlamydia is generally spread through vaginal or anal intercourse; in rare cases, it may be spread through oral sex
• Gonorrhoea is generally spread through vaginal or anal intercourse, though it may also be spread through oral sex
• Hepatitis B can be spread through oral sex

Many individuals are concerned about the risk of HIV/AIDS.^[13] Generally, a person must either have unprotected sexual intercourse (vaginal or anal), use an infected syringe or have the virus passed from mother to child to be infected.^[13] A person cannot be infected from casual contact, such as hugging; however, there is a minor risk that if HIV-infected blood, or genital secretions (semen or vaginal secretions), enter an open wound, the person is at risk.^[13]

The only way for complete protection from pregnancy or STI risk is to completely abstain from all sexual activities. However, there are several ways to decrease the risk, should a person decide to be sexually active.

Some barrier methods include:

• Condoms, which can provide STI protection
• Dental dams, which offer STI protection during oral sex
• Latex gloves, which can be used during mutual masturbation or fingering to prevent the risk of STI transmission

If a person is concerned about the minor risk of pregnancy from non-penetrative sex, there are also several hormonal contraceptive birth control methods that can be used. Dual protection (using both a barrier device and hormonal method) can be significantly effective at preventing both pregnancy and STI transmission.^[58]

See also

• Eroto-comatose lucidity           
• Kunyaza
• Orgasm control
• Physical intimacy
• Sex magic
• Sex party
• Sex position
• 69
• Venus Butterfly

References

1. Michael W. Ross, Lorna D. Channon-Little, B. R. Simon Rosser (2000). Sexual Health Concerns: Interviewing and History Taking for Health Practitioners. University of Michigan. p. 45. ISBN 0803606680.
2. See 272 and page 301 for two different definitions of outercourse (first of the pages for no-penetration definition; second of the pages for no-penile-penetration definition). Rosenthal, Martha (2012). Human Sexuality: From Cells to Society, 1st ed. Cengage Learning. pp. 576 pages. ISBN 0618755713. Retrieved September 17, 2012.
3. Judith LaRosa, Helaine Bader, Susan Garfield (2009). New Dimensions In Women's Health. Jones & Bartlett Learning. p. 91. ISBN 0763765929. Retrieved August 31, 2013.
4. John H. Harvey, Ann L. Weber (2001). Odyssey of the Heart: Close Relationships in the 21st Century. Psychology Press. p. 70. ISBN 1410604055. Retrieved August 30, 2013.
5. Ann O'Leary (2002). Beyond Condoms: Alternative Approaches to HIV Prevention. Springer. p. 155. ISBN 0306467313. Retrieved August 21, 2013.
6. Robert Crooks; Karla Baur (2010). Our Sexuality. Cengage Learning. pp. 286–289. ISBN 0495812943. Retrieved August 30, 2012. Noncoital forms of sexual intimacy, which have been called outercourse, can be a viable form of birth control. Outercourse includes all avenues of sexual intimacy other than penile–vaginal intercourse, including kissing, touching, mutual masturbation, and oral and anal sex.
7. See here onwards and pages 47-49 for views on what constitutes virginity loss and therefore sexual intercourse or other sexual activity; source discusses how gay and lesbian individuals define virginity loss, and how the majority of researchers and heterosexuals define virginity loss/"technical virginity" by whether or not a person has engaged in penile-vaginal sex. Laura M. Carpenter (2005). Virginity lost: an intimate portrait of first sexual experiences. NYU Press. pp. 295 pages. ISBN 0-8147-1652-0. Retrieved October 9, 2011.
8. Bryan Strong; Christine DeVault; Theodore F. Cohen (2010). The Marriage and Family Experience: Intimate Relationship in a Changing Society. Cengage Learning. p. 186. ISBN 0-534-62425-1. Retrieved October 8, 2011. Most people agree that we maintain virginity as long as we refrain from sexual (vaginal) intercourse. But occasionally we hear people speak of 'technical virginity' [...] Data indicate that 'a very significant proportion of teens ha[ve] had experience with oral sex, even if they haven't had sexual intercourse, and may think of themselves as virgins' [...] Other research, especially research looking into virginity loss, reports that 35% of virgins, defined as people who have never engaged in vaginal intercourse, have nonetheless engaged in one or more other forms of heterosexual sexual activity (e.g., oral sex, anal sex, or mutual masturbation).
9. Joseph Gross, Michael (2003). Like a Virgin. The Advocate/Here Publishing. pp. 44–45. 0001-8996. Retrieved March 12, 2011.
10. Karen Bouris (1995). What Parents and Teenage Girls Should Know about "Losing Your Virginity". Conari Press. pp. 133–134. ISBN 0-943233-93-3.
11. Jerry D. Durham; Felissa R. Lashley (2000). The Person With HIV/AIDS: Nursing Perspectives, 3rd Edition. Springer Publishing Company. p. 103. ISBN 8122300049. Retrieved January 29, 2012.
12. "Sexual Risk Factors". AIDS.gov. Retrieved March 4, 2011.
13. Dianne Hales (2008). An Invitation to Health Brief 2010-2011. Cengage Learning. pp. 269–271. ISBN 0495391921. Retrieved August 29, 2013.
14. Seth C. Kalichman (2005). Positive Prevention: Reducing HIV Transmission among People Living with HIV/AIDS. Springer. p. 167. ISBN 0306487004. Retrieved September 1, 2013. The proportion reporting having ever engaged in 'outercourse', defined as sexual contact with neither vaginal nor anal penetration...
15. Boston Women's Health Book Collective, Judy Norsigian (2008). Our Bodies, Ourselves: Menopause. Simon & Schuster. p. 143. ISBN 1439103437. Retrieved September 1, 2013. For some women, outercourse, defined as lovemaking without vaginal or anal penetration...
16. Richard Blonna, Janice Loschiavo, Dan Watter (2011). Health Counseling: A Microskills Approach for Counselors, Educators, and School Nurses. Jones & Bartlett Learning. pp. 170–171. ISBN 0763781568. Retrieved September 1, 2013. [N]onpenetrative sexual pleasure. This group of methods, sometimes called outercourse, provides options for the satisfaction of sexual desire and orgasm that do not involve the penis penetrating the vagina.
17. Lois White, Gena Duncan, Wendy Baumle (2011). Medical Surgical Nursing: An Integrated Approach, 3rd ed. Cengage Learning. p. 1161. ISBN 1133707149. Retrieved September 1, 2013. Some people consider outercourse to mean sex play without vaginal intercourse, while others consider this to mean sex play with no penetration at all (vaginal, oral, or anal).
18. "Non-penetrative". Collins English Dictionary. Retrieved September 1, 2013.
19. "Heavy petting". Oxford University Press. 2013. Retrieved September 1, 2013.
20. M., Hodge; Evelyn Blackwood; Jeffrey M. Dickemann; Doug Jones; Frank Muscarella; Paul L. Vasey; Walter L. Williams (2000). "The Evolution of Human Homosexual Behavior". Current Anthropology. 41: 385–413. doi:10.1086/300145. PMID 10768881.
21. Piepenburg, Erik (February 2006). "What's Rub Got to Do With it?". Out. Retrieved July 4, 2011.
22. Carpenter, Humphrey (1981). W. H. Auden, a biography, Volume 1981, Part 1. Houghton Mifflin Co. p. 48. ISBN 0395308534.
23. Joe Perez (2006). Rising Up. Lulu.com. p. 248. ISBN 1411691733. Retrieved July 4, 2011.
24. Eccentric and Bizarre Behaviors, Louis R. Franzini and Jon Squires, 1995.
25. Fulbright, Yvonne K. (2010). The Better Sex Guide to Extraordinary Lovemaking. Quiver. p. 141. ISBN 9781592333523.
26. Richters, J.; Song, A. (1999). "Australian university students agree with Clinton's definition of sex". BMJ. 318 (7189): 1011. doi:10.1136/bmj.318.7189.1011a.
27. "Handjob". Oxford Advanced Learner's Dictionary. 2013. Retrieved September 1, 2013.
28. Richters, J.; Hendry, O.; Kippax, S. (2003). "When safe sex isn't safe". Culture, Health & Sexuality. 5 (1): 37–52. doi:10.1080/713804637.
29. Alan Brauer & Donna Brauer (1991). The ESO Ecstasy Program: Better, Safer Sexual Intimacy and Extended Orgasmic Response. Warner Books. pp. 24–25. Masters in Johnson ... described female orgasm as "a brief episode of physical release" characterized by either "a series of rapidly recurrent orgasmic experiences between which no recordable plateau-phase intervals can be demonstrated or by a single, long-continued orgasmic episode... status orgasmus is may last from 20 to more than 60 seconds"
30. Patricia Taylor, PhD thesis (2000), In her PhD research study, the average time spent in an EO session was 54 minutes.
31. Morton, Mark Steven (2003). The Lover's Tongue: A Merry Romp Through the Language of Love and Sex. Insomniac Press. p. 186. ISBN 1894663519.
32. axillary intercourse - Dictionary of sexual terms
33. Knaapila, A., Tuorila, H., Vuoksimaa, E., Keskitalo-Vuokko, K., Rose, R. J., Kaprio, J., & Silventoinen, K. (2011). Pleasantness of the Odor of Androstenone as a Function of Sexual Intercourse Experience in Women and Men. Archives of Sexual Behavior, 1-6.
34. "What Is Sensual Massage? | LIVESTRONG.COM". livestrong.com. Retrieved September 23, 2014.
35. Phillips, N. A. (2000). "Female sexual dysfunction: evaluation and treatment". American Family Physician. 62 (1): 127–148.
36. Bruckner, A. (2010). Illustrated Foot Sex: Footjobs & Foot Fetishism. Brian Phillippe.
37. "Intercrural Sex - definition of Intercrural Sex by Medical dictionary". medical-dictionary.thefreedictionary.com. Retrieved September 23, 2014.
38. Cartwright, R., Ben‐Nagi, J., & Smith, R. (2007). Intercrural sex leading to an unexpected pregnancy in a woman with a stenotic vagina secondary to congenital adrenal hyperplasia. BJOG: An International Journal of Obstetrics & Gynaecology, 114(6), 767-768.
39. "Completeorgasmguide.com". completeorgasmguide.com. Retrieved September 23, 2014.
40. Hans, J. D.; Kimberly, C. (2011). "Abstinence, Sex, and Virginity: Do They Mean What We Think They Mean?.". American Journal of Sexuality Education. 6 (4): 329–342. doi:10.1080/15546128.2011.624475.
41. Citation O'Barr, W. M. (2011). "Sex and Advertising". Advertising & Society Review. 12: 2. doi:10.1353/asr.2011.0019.
42. Levin, R.; Meston, C. (2006). "Nipple/breast stimulation and sexual arousal in young men and women". The Journal of Sexual Medicine. 3 (3): 450–454. doi:10.1111/j.1743-6109.2006.00230.x. PMID 16681470.
43. Jerrold S. Greenberg; Clint E. Bruess; Sarah C. Conklin (2007). Exploring the Dimensions of Human Sexuality. Jones & Bartlett Learning. p. 429. ISBN 0-7637-4148-5. 9780763741488. Retrieved December 19, 2010.
44. Janell L. Carroll (2009). Sexuality Now: Embracing Diversity. Cengage Learning. p. 272. ISBN 0-495-60274-4. Retrieved December 19, 2010.
45. Edwards, S.; Carne, C. (1998). "Oral sex and the transmission of viral STIs". Sexually transmitted infections. 74 (1): 6–10. doi:10.1136/sti.74.1.6.
46. Choices, N. H. S. (2012). What is oral sex?-Health questions-NHS Choices.
47. McCarthy, B. W.; Ginsberg, R. L.; Fucito, L. M. (2006). "Resilient sexual desire in heterosexual couples". The Family Journal. 14 (1): 59–64. doi:10.1177/1066480705282056.
48. Arnold, K. D. (2010). "College student development and the hook-up culture". Journal of College & Character. 11: 4. doi:10.2202/1940-1639.1736.
49. Heldman, C.; Wade, L. (2010). "Hook-up culture: Setting a new research agenda". Sexuality Research and Social Policy. 7 (4): 323–333. doi:10.1007/s13178-010-0024-z.
50. Garcia, J. R.; Reiber, C. (2008). "Hook-up behavior: A biopsychosocial perspective". Journal of Social, Evolutionary, and Cultural Psychology. 2 (4): 192–208. doi:10.1037/h0099345.
51. Bradshaw, C.; Kahn, A. S.; Saville, B. K. (2010). "To hook up or date: which gender benefits?". Sex Roles. 62 (9-10): 661–669. doi:10.1007/s11199-010-9765-7.
52. Clutterbuck, D. J.; Flowers, P.; Barber, T.; Wilson, H.; Nelson, M.; Hedge, B.; Sullivan, A. K. (2012). "UK national guideline on safer sex advice". International journal of STD & AIDS. 23 (6): 381–388. doi:10.1258/ijsa.2012.200312.
53. Thomas, R. Murray (2009). Sex and the American teenager seeing through the myths and confronting the issues. Lanham, Md.: Rowman & Littlefield Education. p. 81. ISBN 9781607090182.
54. Edlin, Gordon (2012). Health & Wellness. Jones & Bartlett Learning. p. 213. ISBN 9781449636470.
55. Medley-Rath, S. R. (2007). "Am I still a virgin?": What counts as sex in 20 years of Seventeen". Sexuality and Culture. 11 (2): 24–38. doi:10.1007/s12119-007-9002-x.
56. "STDs :: Planned Parenthood". plannedparenthood.org. Retrieved September 23, 2014.
57. Choices, N. H. S. (2013). Sex activities and risk-Live Well-NHS Choices. Men's health, 18, 39.
58. Reprod Health Matters. 2006 Nov;14(28):162-70.

Further reading

• Ann van Sevenant (2005). Sexual Outercourse: A Philosophy of Lovemaking. Peeters. pp. 249 pages. ISBN 9042916176.
• Ian Kerner (2004). She Comes First: The Thinking Man's Guide to Pleasuring a Woman. HarperCollins. pp. 240 pages. ISBN 0060538252.

External links

• Frot Man2Man Alliance promoting non-penetrative male-to-male sexual expression
• "Great sex without intercourse", NVSH (contains graphics of sexual acts)
• Mutual Masturbation - A biographical collection of personal data for a psychological and sociological study of mutual masturbating as it relates to the habits for both men and women.
• Clitical.com: Mutual Masturbation Female mutual masturbation