Vibrators and Other Sex Toys Are Commonly Recommended to Patients, but Does Size Matter? Dimensions of Commonly Sold Products

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641 Vibrators and Other Sex Toys are Commonly Recommended to Patients, But Does Size Matter? Dimensions of Commonly Sold Products

Debby Herbenick, PhD, MPH,* Kathryn J. Barnhart, MPH,* Karly Beavers, † and Stephanie Benge, MS* *Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA; †California State University, Monterey Bay, CA, USA

DOI: 10.1111/jsm.12798

ABSTRACT

Introduction. Vibrators and dildos are commonly used by women and men in the United States, and are increasingly recommended by clinicians. In addition, sex toys and various household objects are sometimes used for sexual stimulation in ways that pose health risks to their users. Data about the dimensions of such products may inform clinicians’ recommendations. Aim. The purpose of the present study was to assess the sizes (length and circumference) of vibrators and dildos marketed for vaginal or anal insertion on websites that sell sexual enhancement products. Methods. Eight websites that sell sexual enhancement products were identiﬁed for inclusion in the study. The dimensions of vaginal vibrators and dildos listed for sale on each website were noted, and descriptive data were calculated for each website. Main Outcome Measures. Product length and circumference (mean, median, and range). Results. Popular sex toy distributers offer a variety of product sizes. The length of many vibrators and dildos was sized between 4 and 6 in, and circumference was between 4 and 5 in. However, some companies featured products of a considerably larger size than others. Conclusion. Length and circumference of vibrators and dildos varied, but on average approximated mean penile dimensions. Clinicians’ recommendations for use of vaginal or anal products can be enhanced by familiarity and offering additional information about product sizes and retailers. Herbenick D, Barnhart KJ, Beavers K, and Benge S. Vibrators and other sex toys are commonly recommended to patients, but does size matter? Dimensions of commonly sold products. J Sex Med 2015;12:641–645. Key Words. Vibrator; Dildo; Vaginal Capacity; Sex Toy

Introduction US culture and are, in addition to being sold in adult bookstores and sex shops, also commonly ibrators and other sex toys are commonly sold in drug stores, large retail stores, through the V used by women and men in the United Internet, and in-home sex toy parties [4–6]. Addi- States. A 2008 nationally representative study of tionally, most women and men express positive more than 3,000 American women and men ages attitudes toward women’s use of vibrators, includ- 18 to 60 found that about 53% of women and ing a belief that vibrator use can be a part of a nearly half of men reported lifetime solo or healthy relationship [7]. partnered vibrator use. In addition, 32.3% of Sexual enhancement products are not only a women reported lifetime dildo use [1–3]. Such part of couples’ sexual experiences, but vibrators products have become increasingly mainstream in are now commonly recommended by some clini-

NOVOLUTO GMBH IPR2020-00007 Exhibit 2044 EX 2044_001 642 Herbenick et al. cians to enhance sexual desire and facilitate Vibrations, MyPleasure, Pure Romance, and orgasm, or as part of a larger treatment plan for Tantus). The third author reviewed the websites in certain types of vulvar pain [8–10]. Some clinicians Summer 2013 and again in Winter 2014 to identify even sell sexual enhancement products, such as products described as being for vaginal insertion or vibrators, in their practice [11,12]. Research with anal insertion. She recorded data that the websites young, female survivors of breast cancer (a group provided about each product’s length, width, and noted for a high prevalence of sexual difficulties circumference when available (the latter typically associated with treatment) has shown that most being noted as the circumference at the thickest women surveyed expressed an interest in sexual point, for products of variable circumference). Cir- enhancement products such as vibrators [13]. cumference was calculated for products with only However, vibrators and dildos vary in size, width reported on the website. The recorded shape, material, and the kinds of stimulation they product length was specified as the portion of the are marketed as offering (e.g., vaginal insertion, product that can be inserted, or insertable portion, clitoral stimulation, anal insertion, etc), with and not full length of the product. The fourth little published information available to inform cli- author double checked these data in 2014 and nicians’ recommendations. This is particularly edited accordingly to represent new products or to important as it has been well documented that the complete areas of missing data. For seven of the vagina, while variable in size, is variable within a eight websites, data from all available products were known and limited range [14–17], and that vaginal recorded. Given the extremely large selection avail- insertion of objects of certain sizes can be uncom- able on Amazon, a random selection of 25 vaginal fortable for some women. Additionally, anal stimu- vibrators and 25 anal products was included in the lation as part of sexual activities has been reported analyses. by an increasing number of women and men in the United States [18–20], though little is known about the use of anal sex toys outside of the some- Main Outcome Measures what extensive anal foreign body literature [21,22]. The main outcome measures are the product length and circumference provided on or calculated from each company website that was Aims examined. The purpose of the present study was to assess the sizes (length and circumference) of vibrators and Results dildos marketed for vaginal or anal insertion that were available on eight websites that sell sexual Vaginal Vibrators enhancement products. Table 1 shows the mean dimensions, and range of dimensions, for vaginal vibrators and dildos on the eight identified websites that sell sexual enhance- Methods ment products. As can be seen, the mean length We selected eight websites that sell sexual enhance- calculated of vaginal vibrators listed for sale on six ment products and that were known to us (Adam of the eight websites was less than 6 in, and the and Eve, Amazon, Babeland, Early to Bed, Good mean circumference of these was less than 4.5 in.

Table 1 Length and circumference of vaginal vibrators and dildos

Vaginal vibrators Vaginal dildos

Length Circumference Length Circumference Website Mean Range Mean Range Mean Range Mean Range

AdamandEve.com 5.63 2.5–11.0 4.34 1.6–7.85 7 3.5–12.0 5.18 2.36–7.86 Amazon.com 6.67 2.75–15.0 4.87 3.14–7.07 — — — — Babeland.com 5.85 2.75–9.75 4.15 1.88–6.28 6.86 4.5–11.0 4.78 2.36–7.07 Early2Bed.com 5.6 2.0–9.37 4 1.57–6.28 6.4 4.0–11.0 4.71 2.51–7.07 GoodVibes.com 5.18 2.0–9.75 4.05 1.96–5.50 6.89 4.0–11.0 4.78 2.36–7.07 MyPleasure.com 5.42 2.5–10.0 4.27 1.96–6.28 4.89 3.5–6.0 4.3 2.36–5.5 PureRomance.com 5.23 3.0–7.0 4.48 3.0–6.0 N/A 7.0–7.0 N/A 5.0–5.0 TantusInc.com 6.46 4.6–7.2 4.78 3.77–5.89 6.53 4.25–11.0 5 2.51–8.64

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Table 2 Length and circumference of anal vibrators and names, and clinicians cannot be expected to be dildos knowledgeable about the diverse and often Length Circumference changing product names and branding. Clinicians Website Mean Range Mean Range should, however, be aware of the range of product sizes that are available so that they can AdamandEve.com 5.53 3.25–10.0 4.02 0.79–6.3 Amazon.com 5.95 2.5–9.25 4.96 3.46–6.75 guide patients to choose products that are likely Babeland.com 5.57 3.25–7.25 4.15 1.96–5.5 to meet clinical goals rather than cause or con- Early2Bed.com 5.7 2.5–11.0 3.9 2.3–6.3 tribute to patient discomfort or pain, even GoodVibes.com 5.77 3.25–10 4.33 2.36–6.3 MyPleasure.com 4.4 3.5–7.5 3.61 2.36–4.7 though the healthy vagina and rectum of some PureRomance.com 3.5 2.5–4.5 3.25 3.0–3.25 patients may be able to comfortably hold objects TantusInc.com 6.9 4.0–15.0 4.9 3.14–8.64 of (somewhat) larger-than-average dimensions. This study presents data from eight websites that sell sex toys. Data from this study indicate Only Amazon and Tantushad a mean length above that, although insertable sex toys vary in length 6 in (mean length for Amazon products was 6.67 in, and circumference, their average dimensions and for Tantus, 6.46 in) and a mean circumference mostly approximate average penile dimensions above 4.75 in. For vaginal vibrators, Tantusoffered [23–28]. However, the range of available vibrators the most limited range of length and circumfer- and dildos was more limited than the range of ence. In contrast, six websites listed a range of at penile sizes. For example, the length of most vibra- least 7 in, with 2 to 3 in at the shorter end, and 9 to tors and dildos was sized between 4 and 6 in, and 15 in at the long end. circumeference was between 4 and 5 in. On most websites, none of the vibrators or dildos was less Vaginal Dildos than 2-in long, and it was rare for a vibrator to have a length greater than 7 in. Also shown in Table 1 are the dimensions of vaginal In addition to with in-site size variability, there dildos. At the time of data collection, Pure were differences in average product sizes between Romance only sold one nonvibrating vaginal dildo, sites. Patients prone to vaginal or vulvar tearing and thus no mean was calculated. MyPleasure might be best advised to shop for their vaginal offered a more limited range of dildo lengths and vibrators or dildos on sites that feature products of circumferences compared with the other websites. smaller, or at least mostly average, dimensions. Patients can also be counseled about the use of Anal Dildos lubricants or other measures that may minimize Again, products sold on Amazon and Tantus had a risk of genital tearing or trauma. greater mean length and circumference than the Patients may be unfamiliar or uncomfortable products sold on the other six websites. The anal purchasing vibrators or dildos, which might possi- products listed on Pure Romance were more bly lead to a quick selection without much consid- modest in size (with length ranging from 2.5 to eration. Clinicians need to understand the diverse 4.5 in), with products on Babeland and MyPleasure range of sexual enhancement products, such as being somewhat more variable in size (Table 2). A vibrators and dildos, because the size of the product wider range of size options was available on the that a patient chooses, or a clinician recommends, remaining websites. may inﬂuence a patient’s or couple’s experience with the product, including their acceptance or use of it and their likelihood of adhering to a clinician’s Discussion recommendations. Further, some products may be As clinicians increasingly recommend sexual comfortable and/or pleasurable for vaginal or anal enhancement products, such as vibrators and insertion, whereas others may feel uncomfortable dildos, to patients, it is important for clinicians to or even painful to attempt to insert, or cause genital be informed about the range of products their trauma. patients may encounter in the marketplace. Clinicians who perform genital examinations are Sexual enhancement products are widely available accustomed to being sensitive to the limits of com- in the United States, and are commonly sourced fortable vaginal distention. For example, clinicians from a limited range of distributers to numerous may select a smaller-sized speculum, or use lubri- stores. As such, the same vibrator may be sold cant with a speculum, to ease vaginal insertion for by different companies using different product certain patients [29,30]. Issues related to genital ﬁt

J Sex Med 2015;12:641–645 EX 2044_003 644 Herbenick et al. between partners are well known, and clinicians are Also, given the extremely large selection of sexual accustomed to advising patients to use lubricant to enhancement products available for sale on ease intercourse with a partner whose penis feels Amazon, we had to limit our sample and docu- large for a patient’s vagina. Fit is also an issue in mented the dimensions of only a limited number of selecting sexual enhancement products for use, products. However, because so many products are with a key difference between penile–vaginal and duplicated across sites, this should not have posed a toy–vaginal fit, being that a woman can select a toy meaningful limitation to our findings. Also, a that fits comfortably inside her vagina far more strength is that we chose a range of websites, easily than she can select a partner whose penis fits including a large general purpose website comfortably inside her vagina. In regard to sex toy (Amazon), websites that are connected to stores recommendations, clinicians may find it helpful to with retail locations (Adam and Eve, Babeland, recommend lubricant use and, for patients who Early to Bed, Good Vibrations), stand-alone web- experience vaginal or vulvar pain during penile– sites (MyPleasure, Tantus), and a website from a vaginal intercourse, to recommend the use of women’s in-home party company (Pure Romance). insertable vibrators that are smaller in size than The current analysis was also limited to document- one’s partner (at least initially), and/or to recom- ing the dimensions of vaginal and anal sexual mend the use of a clitoral vibrator (assuming, of enhancement products. Subsequent research, course, that the pain is not on or around the glans perhaps in partnership with the industry, might clitoris or worsened by such placement). examine women’s perceptions of vaginal sex toys, We found that the measurements from Amazon their purchase patterns, and their comfort and sat- were particularly difficult to identify as often con- isfaction with use of such products. In the future, flicting measurements for the same dimension (e.g., researchers might also examine whether the mate- length) was available, and products listed on rial or design of the product influences women’s Amazon were less likely to have their insertable comfort or satisfaction with products. Subsequent length identified. That is, some products may be research might also examine the interactions of quite long (e.g., 12 in), but a handle and battery lubricants with various sex toy materials, in addi- pack may comprise 5 of the inches, leaving 7 in as tion to the interaction of certain sex toy materials the insertable length. Our familiarity with the and/or lubricants with vaginally retained contra- sexual enhancement product industry helped us to ceptives such as diaphragms and cervical caps. identify these inaccuracies, and we often had to double check the dimensions of these products on Conclusions multiple websites (again, we note that it is common for products to be sold on multiple websites). For We found that the dimensions of sex toys listed for this reason, clinicians might be cautious in recom- sale on eight websites varied considerably, but that mending Amazon as a primary source for sex toy most websites sold products that, on average, shopping, particularly for individuals or couples approximated mean penile dimensions. Clinicians who are new to purchasing sex toys, as less valid who recommend vaginal or anal sexual enhance- information about product dimensions, including ment products may want to become familiar with insertable length, was available at the time of our the range of retailers and product sizes available, data collection. Alternatively, clinicians who rec- and make their recommendations accordingly. ommend Amazon as a source for sex toys might caution patients to pay closer attention to the size of the product and, if size is a concern, to check Acknowledgments information across multiple websites or to shop The authors would like to thank each of the companies elsewhere. Clinicians who recommend sexual for listing the dimensions of their available products enhancement products to their patients may want online. Such information may be helpful not only to to peruse the websites identified in the present clinicians as they form impressions and recommenda- study, or their local stores or other websites, to tions, but also to consumers in their search for sexual identify retailers that they feel provide adequate health and enhancement products. information about size, as well as other issues (e.g., Corresponding Author: Debby Herbenick, PhD, care and cleaning of products, communicating MPH, Center for Sexual Health Promotion, School of about toy use with a partner, etc). Public Health, Indiana University, HPER 116, Bloom- This study was limited in that we only examined ington, IN 47405, USA. Tel: 812-855-7011; E-mail: eight websites that sell vaginal vibrators and dildos. [email protected]

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Conflict of Interest: The authors report no conflicts of 11 Jannini EA, Limoncin E, Ciocca G, Buehler S, Krychman M. interest. Ethical aspects of sexual medicine: Internet, vibrators, and other sex aids: Toys or therapeutic instruments? J Sex Med 2012;9:2994–3001. Statement of Authorship 12 DePree B. Vibrators, your practice, and your patients’ sexual health: Why you should be offering vibrators and related Category 1 devices to your patients within your established practice, and (a) Conception and Design options for doing so. OBG Manag 2013;25:41–9. Debby Herbenick 13 Herbenick D, Reece M, Hollub A, Satinsky S, Dodge B. Young (b) Acquisition of Data female breast cancer survivors: Their sexual function and interest in sexual enhancement products and services. Cancer Nurs Karly Beavers; Stephanie Benge; Debby Herbenick 2008;31:417–25. (c) Analysis and Interpretation of Data 14 Pendergrass PB, Belovicz MW, Reeves CA. Surface area of the Debby Herbenick; Kathryn J. Barnhart human vagina as measured from vinyl polysiloxane casts. Gynecol Obstet Invest 2003;55:110–3. 15 Pendergrass PB, Reeves CA, Belovicz MW, Molter DJ, White Category 2 JH. The shape and dimensions of the human vagina as seen in (a) Drafting the Article three-dimensional vinyl polysiloxane casts. Gynecol Obstet Debby Herbenick; Kathryn J. Barnhart Invest 1996;42:178–82. (b) Revising It for Intellectual Content 16 Barnhart KT, Izquierdo A, Pretorius ES, Shera DM, Shabbout Debby Herbenick; Kathryn J. Barnhart; Karly M, Shaunik A. Baseline dimensions of the human vagina. Hum Reprod 2006;21:1618–22. Beavers; Stephanie Benge 17 Barnhart KT, Pretorius ES, Malamud D. Lesson learned and dispelled myths: Three-dimensional imaging of the human Category 3 vagina. Fertil Steril 2004;81:1383–4. (a) 18 Herbenick D, Reece M, Schick V, Sanders SA, Dodge B, Final Approval of the Completed Article Fortenberry JD. Sexual behavior in the United States: Results Debby Herbenick; Kathryn J. Barnhart; Karly from a national probability sample of men and women ages Beavers; Stephanie Benge 14–94. J Sex Med 2010;7:255–65. 19 McBride KR, Fortenberry JD. Heterosexual anal sexuality and References anal sex behaviors: A review. J Sex Res 2010;47:123–36. 20 Heywood W, Smith AM. Anal sex practices in heterosexual 1 Herbenick D, Reece M, Sanders S, Dodge B, Ghassemi A, and male homosexual populations: A review of population- Fortenberry JD. Prevalence and characteristics of vibrator use based data. Sex Health 2012;9:517–26. by women in the United States: Results from a nationally 21 Lake JP, Essani R, Petrone P, Kaiser AM, Asensio J, Beart RW representative study. J Sex Med 2009;6:1857–66. Jr. Management of retained colorectal foreign bodies: Predic- 2 Herbenick D, Reece M, Sanders SA, Dodge B, Ghassemi A, tors of operative intervention. Dis Colon Rectum 2004; Fortenberry JD. Women’s vibrator use in sexual partnerships: 47:1694–8. Results from a nationally representative survey in the United 22 Barone JE, Sohn N, Nealon TF Jr. Perforations and foreign States. J Sex Marital Ther 2010;36:49–65. bodies of the rectum: Report of 28 cases. Ann Surg 1976; 3 Reece M, Herbenick D, Sanders SA, Dodge B, Ghassemi A, 184:601–4. Fortenberry JD. Prevalence and characteristics of vibrator use 23 Herbenick D, Reece M, Schick V, Sanders SA. Erect by men in the United States. J Sex Med 2009;6:1867–74. penile length and circumference dimensions of 1,661 sexually 4 Fisher C, Herbenick D, Reece M, Satinsky S, Fischtein D. active men in the United States. J Sex Med 2014;11:93– Exploring sexuality education opportunities at in-home sex toy 101. parties in the United States. Sex Educ 2010;10:131–44. 24 Khan S, Somani B, Lam W, Donat R. Establishing a reference 5 Reece M, Herbenick D, Sherwood-Puzzello C. Sexual health range for penile length in Caucasian British men: A prospec- promotion and adult retail stores. J Sex Res 2004;41:173–80. tive study of 609 men. Br J Urol 2002;109:740–4. 6 Schrobsdorff S. Red-light specials. Newsweek. 2008. Available 25 Ajmani ML, Jain SP, Saxena SK. Anthropometric study of at: http://www.newsweek.com/id/110965 (accessed May 4, male external genitalia of 320 healthy Nigerian adults. 2010). Anthropol Anz 1985;43:179–86. 7 Herbenick D, Reece M, Schick V, Jozkowski K, Middlestadt 26 Promodu K, Shanmughadas KV, Bhat S, Nair KR. Penile SE, Sanders SA, Dodge B, Ghassemi A, Fortenberry JD. length and circumference: An Indian study. Int J Impot Res Beliefs about women’s vibrator use: Results from a nationally 2007;19:558–63. representative probability survey in the United States. J Sex 27 Mehraban D, Salehi M, Zayeri F. Penile size and somatometric Marital Ther 2011;37:329–45. parameters among Iranian normal adult men. Int J Impot Res 8 Brotto LA, Heiman JR, Goff B, Greer B, Lentz GM, Swisher 2007;19:303–9. E, Tamimi H, Van Blaricom A. A psychoeducational interven- 28 Jamison PL, Gebhard PH. Penis size increase between flaccid tion for sexual dysfunction in women with gynecologic cancer. and erect states: An analysis of the Kinsey data. J Sex Res Arch Sex Behav 2008;37:317–29. 1988;24:177–83. 9 LoPiccolo J, Lobitz C. The role of masturbation in the treat- 29 Bates C, Carroll N, Potter J. The challenging pelvic examina- ment of orgasmic dysfunction. Arch Sex Behav 1972;2:163–71. tion. J Gen Intern Med 2011;26:651–7. 10 Phillips NA. Female sexual dysfunction: Evaluation and treat- 30 Harmanli O, Jones A. Using lubricant for speculum insertion. ment. Am Fam Physician 2000;62:127–36. [Editorial]. Obstet Gynecol 2010;116:415–7.

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