The reproductive health field would be non-existent without sex, but conversations about sexuality remain taboo and are often omitted from clinical encounters. Clients report that practitioners rarely ask them about sex, despite the evidence suggesting that discussions about positive sexual experiences and satisfaction (and not merely sexual risk) yield significant benefits for patient health as well as the quality of the provider-patient relationship.,
So here is the proverbial “elephant” in the exam room: penile-vaginal intercourse is much more strongly associated with satisfying orgasm for the person with the penis than for the person with the vagina. Female-assigned people are more likely to experience orgasms through direct stimulation of the clitoris and surrounding structures by way of a hand or mouth, and by way of sex toys such as vibrators or other objects, write Jenny Higgins and Patty Cason in Contraceptive Technology. 
So let’s talk about sex toys.
Sex toys enable exploration and self-satisfaction. Take for example, masturbation, which plays an important role in both sexual activity and in abstinence. Individuals can masturbate solo, or mutually with a partner. In the last year alone, 40% of all women (except women over 70) had masturbated, and 20% had masturbated within the last month. Many of those women used a sex toy such as a vibrator.
Using a vibrator with a partner is common, too. In a cross-sectional survey of over 2,000 heterosexual, lesbian, and bisexual U.S. women, most users felt comfortable using a vibrator with a partner. A significant predictor of sexual satisfaction for heterosexual women was having a partner who knew about and liked that they used a vibrator.
While half of heterosexual women report having ever used a sex toy, three-fourths of women who have sex with women report having ever used a sex toy and one fourth report use in the previous month, according to a cross-sectional web-based survey from 2,192 women who have sex with women. Compared to those who reported not using a vibrator or using one only during masturbation, those who used the vibrator with a female partner scored higher on sexual satisfaction. More likely to use a vibrator in this study? Women who were older, white, and in a long-term relationship.
So, maybe it is time for you to talk about toys. Counselors and providers may wish to emphasize the following points when talking to patients:2
- Use of lubrication is important. A variety of lubricants can be bought at most drugstores.
- A helpful experiment: trying vibrations on different parts of the body. People should try a range of speeds and types of vibrations to see what they like. • Patients should be encouraged to relax and have fun! There is no right or wrong way to use a vibrator; it’s about pleasure.
- Some people like to use vibrators on the clitoris directly (intense); others use them on the lips of the vulva; others use them on the inside of the vagina. Some like to move the vibration around to all three places. Patients won’t know unless they try.
- For most people, arousal that can lead to orgasm occurs when the clitoris, lips of the vulva, and first 1 to 3 inches of the vagina are stimulated.
- People will not become addicted to vibrators or unable to orgasm without them. Vibrators may help someone orgasm more quickly, but they will not create desensitization to the stimulation that leads to orgasms.
Many people enjoy partnered vibrator play. You may want to suggest that your patients use their vibrator with a partner. Reassure your patients that using a sex toy does not mean a partner is not good enough, or that the sex toy will replace the partner or make someone overly reliant on the device to achieve arousal or orgasm. These are common misconceptions, however. Positive communication is the key, as it is in creating any satisfying relationship: listening to and hearing partners who feel threatened and then responding with reassurance about their virility, desirability, and prowess.
More good associations? In a recent nationally representative internet-based survey, women who used vibrators currently or in the past were significantly more likely to have had a gynecological exam during the past year than women who had never used vibrators.
How to help your patients enjoy their toys safely? Counsel them that they should avoid toys that may damage or irritate tissue or cause injury. A list of products that may be associated with the potential for hazard can be found at https://sexualityresources.com/ask-sex-counselor/product-guides/things-you-wont-find-our-website
Inform your patients that the sex toy industry is highly unregulated. You know, those companies making unsafe products with more regard for the cash than for the customers. Look for transparency in what a company’s products are made of and how. Patients avoid toys that are made of toxic materials that contain phthalates; they should seek out toys that do not have a chemical or plastic smell. Safe options include:
- non-porous materials
- 100% silicone
- surgical steel
- sealed ceramic
- medical-grade plastics
Just to get you started, here are websites, mentioned in Contraceptive Technology, that sell sex toys:
 Nusbaum MR, Hamilton CD. The proactive sexual health history. Am Fam Physician 2002;66:1705–1712.
 Nusbaum MRH, Gamble GR, Pathman DE. Seeking medical help for sexual concerns: Frequency, carriers, and missed opportunities. J Fam Practice 2002;51:1–5.
 Blair KL, Cappell J, Pukall CF. Not all orgasms were created equal: differences in frequency and satisfaction of orgasm experiences by sexual activity in same-sex versus mixed-sex relationships. J Sex Res 2017:1–15.
 Higgins JA, Cason P. Sexuality & contraception. In: Hatcher RA, Nelson AL, Trussell J, Cwiak C, Cason P, Policar MS, Edelman A, Aiken ARA, Marrazzo J, Kowal D, eds. Contraceptive technology. 21st ed. New York, NY: Ayer Company Publishers, Inc., 2018
 Herbenick D, Reece M, Sanders SA, Dodge B, Ghassemi A, Fortenberry JD. Women’s vibrator use in sexual partnerships: results from a national representative survey in the Unities States. J Sex Marital Ther 2010;36:49-65.
 Schick V, Herbenick D, Rosenberger JG, Reece M. prevalence and characteristic of vibrator use among women who have sex with women. J Sex Med. 2011;8:3306-3315.
 Schrieber K. How sex toys impact relationships. Do they always increase satisfaction? Psych Today May 2017.
 Herbenick D, Reece M, Sanders S, Dodge B, Ghassemi A, Fortenberry JD. Prevalence and characteristics of vibrator use by women in the United States: results from a nationally representative study. J Sex Med 2009;6:1857–1866.