Noncoital sexual expression provides an important way for many couples to relate to one another, often as an alternative to intercourse. Noncoital sex refers to erotic physi­cal contact that can include kissing, holding, touching, manual stimulation, or oral – genital stimulation—but not coitus. Perhaps one of the most noteworthy changes in the pattern of noncoital sexual adolescent behaviors involves oral sex. A number of recent surveys have shown that the incidence of oral-genital stimulation among teenagers has risen significantly (Brady & Halpern-Felsher, 2007; Halpern-Felsher et al., 2006). The NSSHB Survey found that while oral sex was relatively uncommon among young teens ages 14 and 15, by age 19 over 62% of females and 59% of males had been on the receiv­ing end of oral sex with a partner of the other sex (Herbenick et al., 2010a).

A recent survey of more than 600 high school students in California found evidence of a predictive relationship between oral and vaginal sex. Teenage participants who had experienced oral sex by the end of the 9th grade were three times more likely to have engaged in penile-vaginal sex by the end of the 11th grade as compared to youth who delayed their experience with oral sex until the end of the 11th grade (Song & Halpern- Felsher, 2011).

Many teenagers consider oral sex to be more acceptable in dating situations and sig­nificantly less risky than coitus in reference to health, social, and emotional consequences (Brady & Halpern-Felsher, 2007; Knox et al., 2008). Unfortunately, many teens seem to be unaware of the potential health risks associated with oral sex, including transmission of infections like genital herpes, gonorrhea, and HIV (see Chapter 15).

For some young people noncoital sex is highly valued because it provides perceived opportunities to experience sexual intimacy while technically maintaining virginity. However, the very notion of virginity is problematic for a number of reasons. Most important, defining virginity as the absence of a single act (coitus) perpetuates the twin beliefs that "real sex" equals penile-vaginal intercourse and that virginity involves only heterosexual coitus. What about lesbians, gay men, and heterosexuals who have not experienced coitus but who engage in other forms of sexual behavior, such as mutual masturbation, oral-genital, oral-anal, penile-anal, and genital-genital contact? Are these individuals all "technically virgins"? What about women whose only experience with penile intromission occurred during an act of rape? Are they no longer virgins despite their lack of consent?

The very idea that people can engage in virtually every conceivable form of sexual interaction but one and still remain virgins seems to be a questionable (antiquated?) concept. Perhaps it is time to begin de-emphasizing the term virgin, which is both value laden and exclusive.