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More than half of all U.S. women (and three quarters of women who have sex with women) have used a vibrator, and almost one third have used a dildo. Sexual devices (“sex toys”) are readily available but unregulated; thus, clinicians should be prepared to educate patients about safe use, and perhaps to recommend devices for women with sexual dysfunction.
These may enhance sex or masturbation or be therapeutic for cases of decreased libido, anorgasmia, difficulty with vaginal penetration, partner's erectile dysfunction, and motor or sensory disabilities.
Vibrator: Small motor creating vibrations for internal or external stimulation.
Dildo: Phallus-shaped device for vaginal or rectal penetration; double-sided dildoes have two insertive ends for partnered use.
Strap-on dildo: Wearable harness and dildo combination.
Air pulse generator: Device emitting mild air puffs for clitoral stimulation.
Collision dyspareunia aid: Donut-shaped bumper placed around penile base to prevent deep penetration.
Anal plug: Triangular device with narrow base designed to be held within the rectum by the external anal sphincter.
Have you ever or do you currently use a sexual device, alone or with a partner?
Follow up “yes” answers with questions to assess safe use (e.g., “How often do you clean the device?”).
Would you consider using a sexual device if it would improve your sexual health and wellness?
Trauma: Devices inserted rectally should have flared bases to prevent rectal retention and should be lubricated to protect against trauma.
Glass devices should not be used rectally.
Infection: Bacterial and viral infections can be transmitted through shared devices. Covering such devices with barriers (e.g., condoms), appropriate selection of materials, and routine cleaning are critical.
Human papillomavirus (HPV) can persist on devices.
One case of HIV has been documented to be device-transmitted between cisgender women.
Chlamydia, gonorrhea, syphilis, herpes simplex virus, and trichomoniasis are thought to be device transmissible.
Bacterial vaginosis can be transmitted between female partners sharing devices.
Nonporous materials (e.g., medical-grade silicone, hypoallergenic metals) are more effectively disinfected than porous materials (e.g., inexpensive rubber polymers).
Cleaning with soap and water after each use removes discharge and debris.
Submerging devices in dilute household bleach (0.5% sodium hypochlorite) for 3 minutes or 70% isopropyl alcohol for 5 minutes may provide disinfection, although HPV can persist.
Review manufacturer's instructions before using these techniques, as they may damage some materials.
Autoclaving is the only method that eradicates pathogens; boiling water or a dishwasher sanitize cycle has unknown efficacy and may damage some devices.
Ultraviolet light units promoted for disinfection of sexual devices may not live up to their claims.
Rubin ES et al. A clinical reference guide on sexual devices for obstetrician-gynecologists. Obstet Gynecol 2019 Jun; 133:1259. (https://doi.org/10.1097/AOG.0000000000003262)
Comment
In most practices, discussions of sexual health are limited by available time and the comfort levels of both clinician and patient; nonetheless, opportunities to address sexual issues do exist. For starters, explore device use with women having unexplained recurrent or persistent vaginal or sexually transmitted infections — or those experiencing sexual limitations due to chronic disease, decreased libido, or diminished sexual response.