5 Graduate Student Journal of Psychology 2023, Vol. 20 Copyright 2023 by the Department of Counseling and Clinical Psychology Teachers College, Columbia University Prevalence, Comfort With, and Characteristics of Sex Toy Use in a US Convenience Sample using Reddit.com Emily Fippen1 & George Gaither2 1 Teachers College, Columbia University; Department of Clinical & Counseling Psychology 2 Ball State University, Department of Psychological Science In 2020, the global sex toy market was valued at $33.64 billion, more than double compared to the 2009 value of $15 billion (Grandview Research, 2021). With the sex toy industry growing at an exponential rate, more people throughout the world are having differential experiences with sexually-enhancing tech- nology. Sex toys are now sold in several commercial grocery stores, such as Walmart and Target, and can also be found within sex shops, various stores at shop- ping malls, and on countless websites. The proposed study aims to identify participants’ comfort levels and experiences with sex toys, as well as to identify levels of comfortability among participants who reported pre- vious experiences with sexual assault, sexual dysfunc- tion, and/or Post-Traumatic Stress Disorder (PTSD). Understanding how and why American adults use sex toys and sexual “aids” can allow for a better analysis of why sex remains a taboo topic within the United States, and can inform clinicians on how to best incorporate sex toys and sexual “aids” into therapeutic practice. Sex toys, as defined by Döring and Poeschl (2020), are sexual enhancement products with the intent of improving the nature and quality of sexual experi- ences. Sex toys are material objects that are used di- rectly on the body and include “sexual aids” such as lubrication, bondage, and lingerie. This operation- alization of sex toys emphasizes pleasure and the en- hancement of sexual experiences as it pertains to over- all sexual health and satisfaction. Throughout this study, the terms “sex toys” and “sexual aids” may be used interchangeably, as the term “sexual aids” refers to “an object or device that is primarily used to facil- itate human sexual pleasure” (Miranda et al., 2019,). In the Diagnostic and Statistical Manual of Men- tal Disorders (DSM-V), a sexual dysfunction can be defined as “a clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure” (American Psychiatric Association, p. 423). In the United States, sexual dysfunctions affect approximately 43% of women and 31% of men (Rosen, 2000), some of which include hypo- active sexual desire disorder, erectile dysfunction, orgasmic disorder, and female sexual arousal disor- der. It is noteworthy to mention that the diagno- sis of hypoactive sexual desire disorder has changed with the newest edition of the DSM (DSM-V) and is now enveloped underneath an umbrella diagno- sis titled ‘female sexual interest/arousal disorder’. Currently, little is known about comfortability with toys, especially among individuals with sexual assault or sexual dysfunction-related issues. The pres- ent study aims to explore participants’ levels of com- fortability with and use of various types of sex toys and sexual aids. Further, this study aims to identify Although Döring and Poeschl (2020) have presented findings on the use of a broader range of sex toys from a German national sample, little is known about the prevalence and characteristics of users of a broad range of sex toys in the United States. The present study aims to examine the prevalence, characteristics of, and comfort with sex toys among a sample of American adults (n = 231). Within this study, the term “sex toy” refers to any object used directly on the body (e.g., vibrator, dildo, handheld masturbator), while “sexual aids” refers to items that may enhance sexual plea- sure or libido (e.g., lubrication, aphrodisiacs). We used survey data that was previously collected in 2020 using Red- dit.com/r/SampleSize and Ball State University’s Communications Center to solicit participation. Using data from Döring & Poeschl (2020) to assess sex toy use, we added questions regarding participant comfortability using sex toys in the past. If the participant had never previously used sex toys but would be willing to do so in the future, we asked about the perceived comfort of using a sex toy. We also asked about the perceived positive and negative effects of toy use, as well as a number of possible predictors of use including personality, sexuality, mental health, and trauma-re- lated experiences (sexual assault, sex problems/dysfunctions, being diagnosed with PTSD). Our findings revealed that a significant portion of Americans have previously used sex toys. Among our participants who have never used a sex toy, a significant portion said they would be willing to try doing so in the future. Future research could examine prevalence, comfort with, and characteristics of sex toy use among a more sexually and racially diverse sample. Im- plications for sexual health will be discussed in terms of the Positive Sexuality and Positive Technology frameworks. Keywords: Sex toys, sexual aids, sexual dysfunction, sexual assault, convenience sampling 6 FIPPEN & GAITHER levels of comfortability with sexual aids among par- ticipants who report having ever experienced a sexual assault, sexual dysfunction, and/or PTSD. In addi- tion to past and present sex toy usage, we asked par- ticipants about past experiences with sexual assault, PTSD, and religiosity, as well as perceived positive and negative effects of and comfortability with sex toys. Literature Review Sex Toys Trends A plethora of research regarding sex toys and their users is not currently available, due to a lack of empirical studies. This lack of research may be in- formed by the consideration of many Americans that sex toys, and discussions of sex in general, are taboo. Many discussions about sexual behavior and sexual health are clouded by discomfort, awkwardness, and a negative stigma (Schwallie, 2020). However, a select few studies have been conducted, such as the research by Reece and his colleagues (2010), as well as by Döring and Poeschl (2020). These studies aimed to examine rates of sex toy and sexual aid use among singles and couples, what individual demographics influence people to consume these toys, and exactly what kinds of toys these groups are using. Further, these studies were conducted using nationally repre- sentative samples, which implies that there is a high level of confidence that the data can be generalized to the larger population. Throughout the existing literature, it has been repeatedly found that women are the largest consum- ers of sex toys, especially vibrators, with queer women having the highest rates of use. It has been found in one sample that around 90% of women reported ever hav- ing used sex toys during partnered sex, masturbation, or both (Fahs & Swank, 2013). Approximately 37.3% of women reported ever having used a vibrator during partnered sexual intercourse, while 46.3% reported ever having used a vibrator during foreplay (Herbenick et al., 2009). 85% of women (n = 889) reported feeling comfortable using a vibrator alone while 69.6% report- ed that they feel comfortable using a vibrator with a partner (Herbenick et al., 2010). However, rates of sex toy use during solo masturbation vary by study, with Reece and his colleagues (2010) finding that 46.3% of women have ever used a vibrator alone during mas- turbation. Comparatively, in Döring and Poeschl’s (2020) research, they found that 72% (n = 366) of women – almost three-fourths, reported ever having used a toy designed to stimulate the vagina or vulva during solo sex. Rates of reporting may vary due to fear of judgment, social stigma, or sampling methods, as was reported by participants in Fahs and Swank’s (2013) study. These studies indicate that many wom- en, if not comfortable enough to incorporate sex toys into their solo and/or partnered activities, are at least familiar with different types of sex toys and their uses. An important note to make regarding women’s sex toy use is that attitudes and perceptions tend to vary based on sexual orientation, as demonstrated by the work of Fahs and Swank (2013). Their study exam- ined rates of sex toy use by sexual orientation and found that nonheterosexual women reported less shame and expressed more desire to use toys with a partner, as these women tended not to place such an emphasis on phallocentrism and heteronormativity. Most of the heterosexual women, however, were more concerned about their partner’s attitudes and opinions on their use of sex toys, and feared that their partner would feel sexually inadequate, despite many of these participants reporting that their partner had never expressed these concerns. Because nonheterosexual women tend to not place as much, if any, emphasis on sexual phallo- centrism and heteronormativity, these women were better able to adopt a more playful connotation sur- rounding sex toys, both during solo and partnered sex. Both groups of women were found to vary in their expression of agency in reference to their relationship with and feelings about sex toys, particularly penetra- tive toys, as heterosexual women were more likely to believe that masturbating without penetrative toys was abnormal and a cause for concern, while nonhetero- sexual women did not hold this belief. The work of Fahs and Swank (2013) effectively distinguishes rates of sex toy use among American heterosexual and non- heterosexual women, as well as discusses how sex toys often carry a negatative connotation when discussed within the confines of a heterosexual relationship. Contrary to the popular belief that women use sex toys and sexual aids at higher rates, it has been found that rates of sex toy usage among men and women are similar, with 43.8% of men (n = 423) reporting that they had ever used a vibrator, either during solo or partnered sex (Reece et al., 2010). Comparatively, it was found by Döring and Poeschl (2020) that 34% of men (n = 295) reported ever having used sexu- 7 SEX TOY USE IN THE US al aids designed for the stimulation of the penis and testicles, while 44% had ever used aids designed for the stimulation of the vulva and vagina. Interesting- ly, sex toy usage varies by partnership among men, as has been found in Reece’s and his colleagues’ (2010) research. Reece et al. (2010) found that men in part- nerships were much more likely to report ever having used a vibrator during partnered sexual intercourse, with 43% of men in romantic partnerships and 38% of married men displaying this trend. Comparatively, only 21.3% of single men reported ever having used a vibrator during sexual intercourse with a partner. Ap- proximately one-third of the sample (n = 985) report- ed ever having used a vibrator during masturbation alone. The work of Döring and Poeschl (2020) and Reece et al. (2010) indicate that sex toy use, particular- ly vibrator use, is common among heterosexual men, and is a phenomenon that should be studied further. Similar to “sexual aid” research as a whole, there exists a lack of current research examining the rates and types of sex toy use among gay and bisexually identify- ing men. It has been found that, among gay and bisexu- al men (n = 25,294), nearly 80% report ever having used at least one type of sex toy (Rosenberger et al., 2011), including dildos (62.1%), vibrators (49.6%), butt plugs (34.0%), masturbation sleeves (27.9%), and anal balls or beads (19.3%). A commonly reported phenomenon among gay and bisexual men is inserting a toy, such as a butt plug or dildo, into one’s own anus during mas- turbation (95.7%) or into their partner’s anus (72.0%). Types of Toys Few existing studies have examined exactly what types of toys are being used by the overall popula- tion. In a study that aimed to examine the most used sex toys, as well as hygienic behaviors following their use, it was found that the most popular sexual aid is the vibrator, with 54.53% of people (n = 1,435) with a vulva and vagina reporting that they had ever used any sort of store-bought or homemade vibrator (Wood et al., 2017). Similarly, 21.26% of these people report- ed ever having used a dildo, and 9.26% reported using sexual toys related to BDSM (bondage, dominance, sadism, masochism), such as whips, anal beads, or devices used for restraint. Among heterosexual men, 52% (n = 295) have reported using sex toys designed for the stimulation of the penis and testicles, such as cock rings or handheld masturbators, within the past year during solo sex (Döring & Poeschl, 2020). Com- paratively, 31% of men from the same sample reported using toys designed for the vagina and/or vulva, such as a vibrator, during solo sex within the past year. 26% of men reported ever having used toys for bondage or S&M (sadism and masochism), such as whips or cuffs, and 46% reported ever having used arousal-en- hancing remedies, such as ingesting food or substances that elicit sexual desire (i.e., aphrodisiacs), during solo sex within the past year (Döring & Poeschl, 2020). Sexual Aids as Treatment Sexual aids are increasing in popularity as clini- cian recommended treatments for sexual dysfunc- tions, as well as for anxiety and fear following a sex- ual assault. Nearly all the existing literature on sexual aid recommendation focuses on cancer-related sexual dysfunctions, which result from radiation targeted at the pelvis and surrounding areas. When radiation tar- gets the pelvic area, it may damage nerves and arteries necessary for sexual functioning (American Cancer Society, 2020). Sexual aids have recently been uti- lized for rehabilitation, as they may serve to increase sensitivity, functioning, and pleasure among cancer patients. However, as discovered by Bober and his colleagues (2019), the majority of cancer survivors do not receive adequate support or education about sex- ual health. While exact statistics vary regarding sexual dysfunction as a side effect of cancer treatment, it has been found by Andersen (1985) that 20 to 90 percent of adult cancer patients suffer from significant sexu- al dissatisfaction or dysfunction. However, among these various cancer-treatment centers, only 27% offer sexual aids and rehabilitation for women, while even fewer (13%) offer the same aids for men (Bober et al., 2019). Sexual aids, while serving to increase pleasure and intimacy among couples, can also serve as a form of rehabilitation for individuals suffering from sexu- al dysfunctions resulting from sexual assault, PTSD, and cancer-related treatments. Further, physicians and clinics should make sexual rehabilitation in these instances more accessible to increase sensitivity and functioning among those with sexual dysfunctions. Sexual Dysfunction It has been found that sexual dysfunctions are common within the United States, affecting approx- imately 43% of women and 31% of men (Rosen, 2000). Among these sexual dysfunctions, hypoac- tive sexual desire is most common among women, with about 30% of the female population meet- 8 FIPPEN & GAITHER ing the diagnostic criteria. Erectile dysfunction is the most common sexual dysfunction among men, and rates vary due to the prevalence of this dysfunc- tion growing exponentially with age (Rosen, 2000). Sexual dysfunctions have a variety of causes and may only arise during certain situations or circum- stances. Common psychological causes for sexual dysfunction include stress, anxiety, and depression (Beaumont Health, 2023). It has been found that when performance-related demands were placed on both sexually functioning and sexually dysfunctional men, the sexually dysfunctional men had lower lev- els of sexual arousal due to becoming distracted by the demand and the accompanying performance-re- lated concerns (Barlow, 1986). Sexually dysfunction- al men from the same study also reported that they perceived themselves as having less control over their sexual arousal than sexually functional men, even when levels of erectile response were the same. Cur- rent literature outlines how sexual dysfunctions can have a strong influence on sexual confidence, anxiety, and the sense of control one feels over their sexuality. Further, some common physiological causes for sexual dysfunction include neurological disorders, var- ious prescription medications, alcohol and drug abuse, cancer and related treatments, and sexual assault (Beau- mont Health, 2023). Selective serotonin reuptake in- hibitors (SSRIs), a medication commonly prescribed for depression, are commonly known as having ad- verse side effects, particularly in that they can contrib- ute to the development of sexual dysfunction (Jing & Straw-Wilson, 2016). While the exact cause of sexual dysfunction as a side effect of SSRIs is not known, re- searchers have identified that it is the reuptake process of particular neurotransmitters, such as serotonin or norepinephrine, that influence the emergence of sexu- al dysfunctions (Prabhakar & Balon, 2017). The effects of SSRIs on sexual functioning have been researched, and it has been found that around 40 to 50 percent of both men and women experience reduced levels of sexual arousal when taking an SSRI (Balon, 2006). In relation to cancer, sexual dysfunctions arise when radiation targets areas surrounding the pelvis, such as the prostate, rectum, colon, or ovaries. Further, the psychological implications that may arise from endur- ing cancer treatments may contribute to lasting sexual dysfunctions, such as body dysmorphia resulting from hair loss or a change in weight (Archangelo et al., 2019). The treatment of sexual dysfunctions today orig- inates largely from the work of Masters and Johnson, who became pioneers of sex therapy after the creation and effective execution of sensate focus exercises in 1980 (Auteri, 2014). Sensate focus is a technique used to improve communication between partners regarding sex, reduce sexual performance anxiety, and shift away from goal-oriented expectations toward a more inti- mate and partner-focused experience (SMSNA, 2023). These sessions of non-demanding, sensual touching can increase comfortability with receiving touch from a partner. When exercised alone, this self-exploration can help an individual reclaim their sensuality and confidence. Sensate focus is commonly used for dys- functional problems such as female sexual interest/ arousal disorder, erectile dysfunctions, and male hy- poactive sexual desire disorder. Other commonly used treatments involve hormone therapy, cognitive-be- havioral therapy (CBT), medications, and mechanical aids such as penile implants (Cleveland Clinic, 2020). One increasingly common treatment recom- mendation by sex therapists involves the incorpora- tion of sexual aids or sex toys into masturbatory and partnered sexual activities. Sex toys may increase sen- sitivity and pleasure, and may also help to alleviate anxiety and fear among individuals who have been sexually assaulted (Rullo et al., 2020). However, in- dividuals with dysfunction and/or sexual assault-re- lated histories may be less inclined to use a sexual aid, either alone or with a partner, due to anxiety and fear surrounding sexual behaviors and sensual intimacy (Kaplan, 1974). Appropriate discussions between a client and their clinician are necessary to help deter- mine what aids would be the most beneficial, as well as to determine how and when to use these particu- lar aids. An increasing amount of literature is being made available to help guide the public in their sexu- al-aid endeavors, especially regarding dysfunction and sexual assault. For example, Rullo et al. (2020) posit that “there is no wrong way to use a vibrator. Patients should be encouraged to explore vibrator use all over the body, not just the genitals, and be reminded that vibrator use is for both men and women” (p. 7). These guidelines, and others like them, may help to increase comfortability with the use of sex toys and sexual aids. Sexual Assault According to the Rape, Abuse, and Incest Na- tional Network (RAINN, n.d.), sexual assault can be 9 SEX TOY USE IN THE US defined as: sexual contact or behavior that occurs without explicit consent of the victim. Some forms of sexual assault include: at- tempted rape, fondling or unwanted sex- ual touching, forcing a victim to perform sexual acts, such as oral sex or penetrating the perpetrator’s body, [and] penetration of the victim’s body, also known as rape. Rates of sexual assault among women is a topic that has been highly researched, with previous find- ings indicating that upwards of 20 to 30 percent of women have experienced rape or attempted rape at least once during their lifetime (Koss, 1993, as cit- ed in Ullman & Brecklin, 2002). Sexual assault is the least reported violent crime, with less than one-third of sexual assaults being reported to law enforcement (RAINN, n.d.). Reasons for not reporting an assault may include fear of retaliation by the perpetrator, a be- lief that law enforcement won’t succor the situation, or a belief that the incident wasn’t severe enough to report. The reporting of a sexual assault is less frequent among male victims, as men may be reluctant to report instances of sexual assault due to a widespread societal belief that men are perpetrators, not victims, or due to the belief by the victim that the incident was not actually assault (Ullman & Brecklin, 2002). Further, a common physiological response to anxiety or fear is sexual arousal, and many instances of sexual assault are discounted legally because the victim retained an erec- tion and/or experienced ejaculation during the assault (Bullock & Beckson, 2011). Regardless of reporting status, experiencing a sexual assault has been found to be highly correlated with a decline in mental health (Ullman & Brecklin, 2002), as well as the development of post-traumatic stress disorder (PTSD). Sexual as- sault may lead to serious mental and physical health complications and can contribute to the development of a sexual dysfunction. Further, various assault-re- lated factors, such as the severity of the assault or per- ceived level of social support, can influence the severity and duration of implications following the assault. According to the CDC (2021), nearly one in five American women are victims of attempted or com- pleted rape, and one in three female rape victims first experienced an assault between the ages of 11 and 17. Additionally, it is estimated that around 30% of cur- rent PTSD diagnoses were a direct result of sexual as- sault or sexual violence (Texas A&M Health, 2019). Following an assault, common responses among women include panic attacks, flashbacks, depression, sexual dysfunctions, anxiety, and phobias, as well as an increase in overall anger, fear, guilt, and alcohol and drug abuse (US Department of Veterans Affairs, n.d.). Currently, cognitive-behavioral therapy (CBT) is the most common form of psychotherapy used to treat in- dividuals dealing with psychological problems, such as dissociation or PTSD, following a sexual assault. Many treatments have been empirically proven to improve individual symptoms dependent from PTSD, such as anxiety and depression, these treatments are often incorporated into a multifaceted treatment plan. Re- cently, treatment plans began recommending the use of sexual aids, as “vibratory stimulation of the genitals is an evidence-based treatment” (Rullo et al., 2020, p. 2) for many sexual dysfunctions, including hypoactive sexual desire in men and female sexual interest/arous- al disorder. Through the process of psychotherapy, victims of sexual assault are helped to recognize and target their feelings about the assault, and to increase their levels of self-confidence and comfortability. Experiencing a sexual assault may result in sexual dysfunction or related issues, such as post-traumat- ic stress disorder (PTSD). Current treatments for individuals suffering from psychological afflictions following a sexual assault include cognitive-behav- ioral therapy (CBT), sensate focus exercises, the pre- scription of SSRIs, and individual and/or couples’ therapy (Falsetti & Bernat, 2000). It has been de- termined by previous research that psychotherapy is necessary to restore declining mental health fol- lowing a sexual assault (Kaplan, 1974). Addition- ally, research suggests that using sex toys or aids is beneficial in overcoming physiological implications following an assault, such as dysfunction issues and their accompanying psychological implications. The Present Study Previous literature has briefly examined sex toy and sexual aid use, as well as explored demographic trends for each. However, the literature fails to ex- amine levels of comfortability among individuals, as well as potential willingness regarding sex toy use. The present study aims to expand on the conversation held by Herbenick and her colleagues (2010) regard- ing participant comfortability with sexual aids in solo 10 FIPPEN & GAITHER and partnered sexual behaviors. Further, no current re- search exists on the correlations among sexual assault, sexual dysfunction, PTSD, and sex toy and sexual aid use. The present study aims to fill these gaps by ask- ing participants about their previous experiences using and researching sex toys, their levels of comfortability or willingness regarding these toys, and how levels of comfortability may be influenced by a previous history of sexual assault, dysfunction, and/or PTSD. Under- standing American adults’ comfortability and will- ingness to use sex toys can potentially provide insight into why sex remains a taboo topic within the Unit- ed States, how to best introduce sex toys into one’s sexual practices, and how to incorporate sex toys and sexual aids most comfortably into sexual assault and dysfunction related treatments. The present study was influenced by the work of Döring and Poeschl (2020), as their study introduced an important aspect of participants’ sexual ideology by asking participants about their self-perceived positive and negative effects, giving valuable insight into rates and trends regarding sex toy usage. Data provided by the participants of this study will be analyzed in accordance with the Posi- tive Sexuality and Positive Technology frameworks. The Positive Sexuality framework views sexu- ality through a pragmatic yet multidisciplinary lens while addressing the full range of positive and nega- tive implications that arise from engaging in sexual behavior. By analyzing sexuality through a positive framework, socially negative sexual stigmas can be avoided, and sexuality can be understood as a means of individuality, interrelationship strengthening, plea- sure, and peacemaking (Williams, 2015). Further, this framework acknowledges the risks and negative con- sequences that can accompany sexuality and sexual behavior. To combat these negative implications, the Positive Sexuality framework emphasizes education and communication as a means of understanding. The Positive Technology framework views tech- nology as a means of “fostering personal growth and individual integration in the sociocultural environ- ment, by promoting satisfaction, opportunities for action, and self-expression” (Riva et al., 2012, p. 69) Technology, in some capacity, can influence and en- hance nearly every constituent of human experiences and overall functioning. Further, this framework con- siders sexual aids to be not only devices used for plea- sure, but also therapeutic aids that can help to reduce sexual anxieties, physical pain, sexual dysfunctions, and the accompanying implications that these factors may have on sexual functioning. In combination with the Positive Sexuality framework, sex toys and sexual aids can be viewed as a technological innovation that could potentially help millions of people become more comfortable with their bodies and sexualities. Purpose and Hypotheses The purpose of this study is to better under- stand the prevalence of Americans’ sex toy and “sexual aid” use through the lenses of the Pos- itive Sexuality and Positive Technology frame- works. The following hypotheses were generated: Hypothesis 1: Women will report higher rates of sex toy and sexual aid usage than men, as found by Döring & Poeschl (2020). Hypothesis 2: Compared to men, women will report higher usage of sex toys designed to stimulate the vul- va and vagina, and lower usage of sex toys designed to stimulate the penis and testicles, during only mastur- batory behavior, as found by Döring & Poeschl (2020). Hypothesis 3: Among participants who report that they have never used a sex toy but would be willing to, there will be no significant difference between men and women in levels of willingness to use sex toys. Hypothesis 4: Women will report more comfort us- ing and researching sex toys than men. Hypothesis 5: Among women, the most used sex toys will be toys designed for stimulation of the vagina and vulva, as found by Wood et al. (2017). Hypothesis 6: Among men, the most used “sexual aid” will be toys designed to stimulate the penis and testicles. Hypothesis 7: Participants with a history of sexual assault will be less likely to report using sex toys and sexual aids for both solo and partnered sexual activity. Hypothesis 8: Regarding sexual assault and sex toy use, there will be a gender effect such that women who report having experienced a sexual assault will be sig- nificantly less likely to have used toys than those who haven’t. However, there will be no difference in sex toy usage between men who have and have not been sexu- ally assaulted. Hypothesis 9: Regarding sexual dysfunction and sex toy use, there will be a gender effect such that men who report having experienced a sexual dys- function will be significantly more likely to have used toys than those who haven’t. However, there will be 11 SEX TOY USE IN THE US no difference in sex toy usage among women who have and have not experienced a sexual dysfunction. Method Participants The data collected by Dr. Gaither and his students was obtained largely through Reddit, using conve- nience sampling. A total of 311 participants entered the survey, while 231 fully completed the survey, as some participants exited the survey early. The only exclusion criterion for this study included being un- der the age of 18. Participants of this study (n = 231) were between the ages of 18 and 71 (M = 24.89, SD = 8.59). Slightly over two-thirds of participants were women (68.3%, n = 224), compared to 26.5% of the participants being male (n = 87). For racial demo- graphics, 82.9% of participants were Caucasian (n = 272), 3.4% were Hispanic (n = 11), 3.0% were Asian (n = 10), 2.4% were African American (n = 8), 1.4% were Latinx (n = 4), 0.3% were Pacific Islander or Native Hawaiian (n = 1) and 4.9% reported being of another race not listed (n = 16). Most participants identified as heterosexual (63.7%, n = 209), while 18.0% identified as bisexual (n = 59), 3.7% identified as gay (n = 12), 4.0% identified as lesbian (n = 13), 3.7% identified as pansexual (n = 12), 2.4% identified as asexual (n = 8), and 2.4% identified as another sexual orientation not listed (n = 8). When asked about levels of religiosity, 48.5% of participants reported that they were not at all religious (n = 159). Similarly, 25.0% reported that they were slightly religious (n = 82), 15.9% reported that they were moderately religious (n = 52), 7.3% re- ported that they were very religious (n = 24), and 1.2% reported that they were extremely religious (n = 4). When asked, “have you ever been sexually assault- ed?” 34.5% of participants responded with yes (n = 113). When participants were asked “have you ever been diagnosed with Post- Traumatic Stress Disorder (PTSD)?”, 9.5% of participants responded with yes (n = 31). When asked, “have you ever had problems func- tioning sexually?”, 32.0% of participants responded with yes, I have had some problems with functioning sexually, but have never been officially diagnosed with a sexual dysfunction (n = 105), while 2.4% responded with yes, I have been diagnosed with at least 1 sexual dysfunction in my life (n = 8). There was no incentive provided to participants for completing the survey. Measures/Materials Participants completed a survey that contained several subscales within it. As part of a larger study, participants completed several items that included demographics, comfort, use of toys, experiences with assault and dysfunction, and measures of personality. Questions regarding specific variables (e.g., previous experiences using sex toys, sexual assault, sexual dys- function, etc.) were concise and straightforward to make sure participants fully understood each item. This study will not explain all variables utilized in the survey and will only explain relevant variables. Vari- ables excluded from the analysis and discussion include satisfaction and personality. Self-perceived positive and negative effects, while not part of the initial anal- ysis, will be explored more in the discussion section. Sociodemographic Characteristics The first set of items were demographic items includ- ing age, race, gender, sexual orientation, birth country, and levels of religiosity. Experience with sexual assault was assessed with single item (“Have you ever been sex- ually assaulted?”), with response options of yes and no. Use & Comfort with Use of Sex Toys The next section of the survey asked participants about their previous experience with sex toys and sex- ual aids. Items asked participants about their previous experience with sex toys, if they had ever researched a sex toy, what sex toys they had previously used, levels of comfortability with using and researching sex toys, comfortability with attending a sex toy party, and per- ceived positive and negative effects of using a sex toy. Examples of survey items include “have you ever looked into, or researched sex toys?” and “have you ever used a sex toy for masturbation?” with response options of yes, no but I would be willing to do so in the future, and no and I cannot see myself ever doing so. If respondents answered yes, they were taken to a follow-up question that asked, “How comfortable were you when you researched sex toys (or when you used a sex toy for masturbation)?”. Response options for comfortability items utilized a 7-point Likert scale, which ranged from extremely comfortable (1) to extremely uncomfortable (7). If respondents an- swered no but I would be willing to do so in the fu- ture, they were taken to a follow-up question that asked, “How comfortable do you think you would be if you were to research sex toys (or if you were to use a sex toy for masturbation)?” Response options 12 FIPPEN & GAITHER for expected comfortability ranged from extreme- ly comfortable (1) to extremely uncomfortable (7). If respondents answered no and I cannot see myself ever doing so, no item regarding comfortability was presented. For comfort items, higher numbers with- in the data indicate lower levels of comfortability. Sexual Dysfunction The next section of the survey, which had three items, asked about participants’ previous history with sexual dysfunction. Present survey items were based on items from the 1992 National Health and Social Life Survey, which aimed to better understand Amer- icans’ various sexual practices, as well as the surround- ing life circumstances and social contexts in which these practices occur. An example of one of the survey items includes “have you ever had problems function- ing sexually or been diagnosed with a sexual dysfunc- tion?” with response options including no I have never had any problems functioning sexually, yes I have had some problems with functioning sexually, but never been officially diagnosed with a sexual dysfunction, and yes, I have been diagnosed with at least 1 sexual dysfunction in my life. If respondents answered this item with anything other than no I have never had any problems functioning sexually, they were taken to a follow-up question, also modeled from the NHSLS, that asked about the specific sexual dysfunction that the respondent has experienced. Respondents were asked to report on whether they have experienced lack- ing desire for sex, arousal difficulties, inability achiev- ing climax or ejaculation, anxiety about sexual perfor- mance, climaxing or ejaculating too rapidly, physical pain during intercourse, and not finding sex pleasur- able. For each of these dysfunctions, respondents were presented with response options of yes and no. Procedure Recruitment ads for the study (i.e., convenience sampling) were posted on reddit.com/samplesize and on the Ball State University Communications Center during the Fall of 2020. People who were interested in participating clicked on a link to the anonymous survey which began with a study information and consent page. Those who did not click “I agree” were skipped to the end of the survey; otherwise, they en- tered the survey. The first question asked for age; any- one who typed in a number less than 18 was skipped to the end of the survey. Those who remained in the survey answered questions about demographics, ex- periences and comfort with sex toys from a variety of perspectives (e.g., ever researched toys, used them, bought them, attended a party, etc.). Participants also completed items regarding whether they had ever been sexually assaulted, diagnosed with PTSD, experienced problems in sexual functioning, or been diagnosed with a sexual dysfunction. They completed short forms of the Openness and Extraversion subscales of the Big Five Inventory, the behavioral subscale of the SocioSexual Orientation Inventory, and the Sexual Esteem subscale of the Sexuality Scale. Finally, partic- ipants completed items regarding their relationship and sexual satisfaction, as well as their perceived effects of sex toy use. Once participants reached the end of the survey, they were thanked for their participation. The data was analyzed using SPSS software. A se- ries of frequency tests, chi-square, one-way ANOVAs (cross tabulations), and independent samples t-tests were conducted to examine the data and to compare with the generated hypotheses. Frequency tests were used to analyze demographic information and to ob- tain the frequencies of the number of participants for individual items. The chi-square crosstabs were used to better uncover the correlation between specific variables, such as sex toy use and previous experienc- es with sexual assault. Crosstabs were used to analyze means between various groups of conditions, such as between male and female sex toy users who either have or have not been sexually assaulted. T-tests were used to measure the means between two groups regard- ing various items, such as measuring the mean com- fort level when using a sex toy during masturbation among individuals who report that they have or have not dealt with sexual functioning issues. Significance levels were adjusted using the Bonferroni correction method to attribute for running multiple analyses Results Acquisition of Sex Toys Both male and female participants of this sample (N = 231) were overall well acquainted with sex toys and sexual aids. A series of frequency tests were run, split by gender, to better understand the prevalence of participants’ acquisition on each item. 84.2% of all participants reported that they had ever researched or looked into sex toys, and 80.4% said that they had looked at sex toys in an online shop. 41.8% of par- ticipants had ever spoken to someone else about sex 13 SEX TOY USE IN THE US toys, and 17.7% had ever received a sex toy as a gift. A majority of the sample (69.8%) had ever bought a sex toy themselves. A series of crosstabs were also run to determine statistical significance regarding the acqui- sition of sex toys between the genders. Overall, there was no significant difference between men and women on measures of acquisition of sex toys, except for items that asked about sex toy parties. There were no men within the sample that reported ever being invited to a sex toy party or ever hosting a sex toy party. Because none of the men reported that they had ever been in- vited to attend a sex toy party, they were not shown the follow-up question “Have you ever attended a sex toy party that someone else hosted?” However, 13.8% of male participants who reported that they had never hosted a sex toy party also reported that they would be willing to host a party in the future (p = .002, see Table 1). Among female participants (n = 224), 63.7% reported that they had ever attended a sex toy party, and 5.5% reported that they had hosted a sex toy party. Sex Toy Use, Comfort, & Willingness in Solo Sex Sex toy use was analyzed by running a series of crosstabs to determine statistical significance during masturbation between the genders. All percentag- es regarding sex toy use, comfort, and willingness in solo sex can be found within Table 1. Most partici- pants (70.4%) reported that they had ever used a sex toy during solo sex, while 19% reported that they had not yet, but would be willing to do so in the future. Women reported using sex toys more than men during masturbation, with 76.1% of women reporting ever having used a sex toy during solo sex, compared to 63.1% of men (p = .04, see Table 1). This finding pro- vides support for the first hypothesis. Among women, the most used sex toys and sexual aids during mastur- bation included toys designed for the stimulation of the vagina and vulva (69.2%), lubricants (42.9%), and erotic lingerie (22.8%). Among men, the most used sex toys and sexual aids during masturbation included lubricants (47.1%), toys designed for the stimulation of the penis and testicles (42.5%, p < .001, see Table 2), and toys designed for the stimulation of the vagi- na and vulva (26.4%). Although a notable number of men reported having used toys designed for the stimulation of the vagina and vulva, women were sig- nificantly more likely to use these same toys during masturbation (p < .001, see Table 2), and this pro- vides support for the second hypothesis. Percentages regarding specific sex toys can be found in Table 2. An independent samples t-test, split by gender, was run to determine the means of comfortability re- garding sex toy use during solo sex for each item, with lower means representing higher levels of comfortabil- ity. Women largely reported being slightly more un- comfortable (M = 1.70, SD = 1.17, d = -.05) when having used a sex toy during masturbation compared to men (M = 1.64, SD = 1.19; see Table 3). Overall, there were no significant differences between men and women on items of comfort, except that men report- ed feeling significantly more comfortable, t (153) = -2.32, when researching a sex toy (M = 2.09, d = -.29, p = .022) compared to women (M = 2.51, see Table 3). These findings are directly contradictory to the fourth hypothesis. Overall, men reported higher comfort with all items relating to acquisition (e.g., research, talking to others, purchasing, receiving a toy as a gift), as well as use during masturbation and partnered sex- ual activity. These data could be skewed by the dispro- portionate number of women to men, but the women within this sample consistently reported slightly high- er levels of discomfort than the men on all measures. A series of crosstabulations were run to determine statistical significance among participants who have never used a sex toy during masturbation but would be willing to do so in the future. Among individuals who have never used a sex toy but would be willing to, there were no significant differences between men and women on willingness to use sex toys during mastur- bation, except that men reported significantly more willingness, X2(1) = 28.56, to try toys designed for the stimulation of the penis and testicles than women (p < .001; see Table 1). This finding is directly contradicto- ry to hypothesis three, which predicted no difference in levels of willingness between the genders. Trends reflect that men within this sample are more willing to try lubricants, remedies for enhancing arousal, and toys designed for the stimulation of the penis and testicles, whereas women are more willing to try erotic lingerie, toys designed for the stimulation of the vagina and vulva, and toys for bondage and S&M. Sex Toy Use, Comfort, & Willingness in Partnered Sex All percentages regarding sex toy use, comfort, and willingness in partnered sex can be found within Table 1. 46% of men and 55.4% of women reported ever having used a sex toy during partnered sexual ac- 14 FIPPEN & GAITHER tivity, which was analyzed through a series of cross- tabulations. Although there was no statistically sig- nificant difference among men and women for types of toys used during partnered sex, trends indicate that women are more likely to have used erotic lingerie (33.5%) and toys for stimulation of the vagina and vul- va (46.9%) during partnered sexual activity within the past 12 months. Men and women were about equally likely to have used lubricants (35.6% of men vs. 40.6% of women), remedies for enhancing arousal (4.6% vs. 5.8%), toys designed for the stimulation of the penis and testicles (19.5% vs. 15.2%), and toys for bondage and S&M during partnered sexual activity (21.8% vs. 23.2%) within the same time frame. Percentages regarding specific sex toys can be found in Table 2. Interestingly, trends indicate that men reported being more willing to try every sex toy listed during intercourse with a partner than women, as analyzed through a series of crosstabulations. There was a sta- tistically significant difference in that men reported being more willing to try toys designed for the penis and testicles during partnered intercourse than wom- en (p < .001). This data reflects that men and women are about equally as likely to try various sexual aids and sex toys during masturbation, other than toys designed for the penis and testicles, but that men are more will- ing than women to incorporate toys into partnered sexual activity. This finding challenges the dominant heteronormative belief that most men are against bringing sex toys into partnered sexual activities. Sex Toy Use & Comfort Among Victims of Sexual Assault All factors relating to the use and comfort of sex toys among victims of sexual assault were analyzed through a series of crosstabulations and independent samples t-tests. 13.8% of men within the sample report- ed ever having experienced a sexual assault, compared to 41.7% of women, as shown through a frequency analysis. Among men who reported ever having experi- enced a sexual assault, 81.8% reported ever having used a sex toy during masturbation, while 9.1% reported that they had not but would be willing to do so in the future. Among women who experienced an assault, 81.5% had ever used a sex toy during masturbation, while 15.2% reported that they had not but that they would be willing to do so in the future. It is notewor- thy to emphasize that nearly an identical percentage of men and women who have been sexually assaulted reported using a sex toy during masturbation (81.8% vs. 81.5%), and that men reported slightly higher rates of toy use during masturbation compared to women. Among men who have been sexually assault- ed, 63.6% reported ever having used a sex toy during partnered sex, while 36.4% reported that they had not but that they would be willing to do so in the future. None of the men who reported having been sexually assaulted reported that they would never be willing to try sex toys during partnered sex. Among women who have been sexually assaulted, 68.9% re- ported that they had ever used a sex toy during part- nered sex, while 21.1% reported that they had not but that they would be willing to do so in the future. Although not statistically significant, it is note- worthy to mention that trends indicate that both men and women who have been sexually assaulted are more likely to have used toys than those who have never been sexually assaulted, both during masturbation and sex with a partner. This finding directly contradicts the seventh hypothesis and slightly contradicts the eighth hypothesis in that there was no gender effect for sex toy use among those who have been sexually assault- ed. However, both men and women who have been sexually assaulted also reported lower levels of com- fortability during their previous experiences using sex toys. Among participants who have never been sexual- ly assaulted, men reported more comfortability on all items. The reverse effect was found among participants who reported ever having experienced a sexual assault in that men reported much lower levels of comfortabil- ity than women who have been sexually assaulted. Among men who have ever used toys during mastur- bation, those who have been sexually assaulted report- ed much lower levels of comfortability (M = 2.33) than those who have never been assaulted (M = 1.64). Among women who have ever used sex toys during masturbation, those who have been assaulted reported only slightly lower levels of comfortability (M = 1.76) than those who have never been assaulted (M = 1.70). Among men who have ever used sex toys during part- nered sex, those who reported ever having experienced a sexual assault reported much lower levels of com- fortability (M = 2.71) than those who have never been assaulted (M = 1.75). Among women who have ever used a sex toy during partnered sex, those who reported ever having experienced a sexual assault reported only slightly lower levels of comfortability (M = 1.95) than 15 SEX TOY USE IN THE US those who have never experienced a sexual assault (M = 1.90). The potential factors contributing to this phe- nomenon will be discussed in the discussion section. Sex Toy Use & Comfort Among Those with Sexual Dysfunctions Toy use and comfort among participants who have at least one sexual dysfunction were analyzed through a series of crosstabulations. 32.2% of men and 35.7% of women reported ever having experi- enced problems with sexual functioning, either with or without a formal diagnosis. Among men who re- ported ever having experienced a sexual dysfunction, 17% reported that they had ever used a sex toy during masturbation, while 5.0% reported that they had not but that they would be willing to do so in the future. Similarly, 17.5% of men in the same subsample re- ported that they had ever used a sex toy during part- nered sex, while 11.8% reported that they had not but that they would be willing to do so in the future. Among women who reported ever having experi- enced a sexual dysfunction, 45.2% reported that they had ever used a toy during masturbation, while 35.9% reported that they had not but that they would be will- ing to do so in the future. Similarly, half of the women who reported ever having experienced a sexual dys- function (50.0%) also reported that they had ever used a sex toy during partnered sex, while 27.9% reported that they had not but that they would be willing to do so in the future. Although not statistically signif- icant, both men and women who reported having experienced a sexual dysfunction also reported using sex toys during both masturbation and partnered sex- ual behavior at lower rates than those who have nev- er experienced a sexual dysfunction. This finding re- futes hypothesis nine, seeing as both men and women who have a sexual dysfunction reported lower rates of sex toy use than those without a sexual dysfunction. Regarding comfortability using sex toys among those with sexual dysfunctions, women reported lower levels of comfortability on both items of masturbation (M = 1.84) and partnered sex (M = 2.02) than those who have never experienced a sexual dysfunction. Among men, those who reported ever having experienced a sexual dysfunction reported feeling more comfortable when using a sex toy during masturbation (M = 1.37) compared to those who have never had a sexual dysfunction (M = 1.79). However, the reverse effect was found during partnered sex, in that men who reported having experienced a sexual dysfunction reported less comfortability when using a sex toy with a partner (M = 1.81) compared to those who have never had a sexual dysfunction (M = 1.71). Discussion Sex toys and sexual “aids” have existed throughout history and all over the world to help promote sexual stimulation and physiological responses. Since the rise of modern technology, the sex toy market has blos- somed into a multi-billion-dollar industry, primarily emphasizing sexual pleasure. However, sex toys can also harbor a therapeutic function, eliciting sexual re- sponsiveness among those with sexual dysfunctions. Further, sex toys can be a means of regaining com- fortability with sexuality and sexual intimacy among individuals who have experienced a sexual assault (Rul- lo et al., 2020). The findings of this study correlate with the Positive Sexuality framework, seeing as participants acknowledged both the positive and negative effects of sex toy use, but also reported a significant level of will- ingness to learn about and use sex toys in the future. The empirically proven benefits of sex toys and sexual aids for dysfunction and assault-related implications align with the Positive Technology framework in that sex toys and sexual aids, through means of increasing sensitivity and overall pleasure, serve to increase sexual functioning as well as the overall quality of life for users. American participants within this sample have re- ported considerate sex toy use, both during solo and partnered sex. Men and women reported similar rates of sex toy use, both during solo and partnered sex, al- though women consistently reported higher usage of sex toys overall. Similarly, among those who reported that they have never used sex toys, a decent percentage reported that they would be willing to try incorporat- ing them into their masturbatory or partnered sexual behavior. This data indicates that most American adults who have not experienced using sex toys would be willing to try one in the future. The sex toy indus- try should consider this group of willing individuals as an entirely separate group of consumers and should market to this group accordingly. Sex toy shops and websites are often hypersexualized and intimidating environments. Further, sex toy shops can be very over- stimulating, expensive, and confusing for first-time buyers, and perhaps a different approach to sex toy con 16 FIPPEN & GAITHER sumerism would benefit those who are willing to try sex toys but have not yet been able to have that experi- ence. This approach could include a less overtly sexual environment, as well as an emphasis on education and pleasure for all participating individuals, as opposed to some typical sex shops that advocate for the infantiliza- tion, domination, and hypersexualization of women. When compared to the results of Döring & Poeschl’s (2020) study, participants in the present study reported higher rates of sex toy use during masturbation when compared to partnered sex. However, rates of sex toy use were similar between German and American participants among items of partnered sexual activity. The only item in which Germans scored higher than American participants was on measures of sex toy use during partnered sex, in which German men reported higher usage of sex toys than American male participants. This find- ing indicates that perhaps Germany, and Europe at large, has a more relaxed and sex-positive stance on sex toys, and thus are used more during partnered sex. Among participants of the present study, women re- ported higher rates of sex toy use during both mastur- bation and partnered sexual activity. Women reported higher usage of sex toys designed to stimulate the vagi- na and vulva overall, while men reported higher usage of toys designed to stimulate the penis and testicles - which provides support for hypotheses five and six. Trends indicate that men are more willing to try all toys listed in the survey during partnered sex, with the only statistically significant finding being that men were significantly more willing to introduce toys designed for the penis and testicles into partnered sexual activity than women were?. This finding directly counters the assumption by many women that men are unwilling or uncomfortable with incorporating sex toys into part- nered sexual activities (Fahs & Swank, 2013). Open communication between sexual partners is necessary to establish willingness and comfortability with in- corporating sex toys into partnered sexual behaviors. There exists a toxic, heteronormative belief that most men are against the incorporation of sex toys into part- nered sexual activity due to the accompanying belief that men should be able to completely satisfy their partner on their own, with their own bodies. However, the present data is directly contradictory to this harm- ful belief, as it was found that many men are willing to incorporate sex toys into partnered sexual activity. Accompanying this willingness should be education. Sex toy parties are one safe environment to learn more about different kinds of sexual “aids”. Among the men in our sample, 13.8% reported that they would be will- ing to host a sex toy party if given the opportunity, this was found to be statistically significant. Because various state laws (Alabama Anti-Obscenity Enforce- ment Act, 1998; Texas Public Indecency Act, 1973) consider the sale of sex toys to be a form of solicitation, men are often not allowed at sex toy parties. Further, many sex toy companies, such as Pure Romance, claim that “having some men in attendance would make some women uncomfortable” (Sex Toys, 2021). Due to these hindrances in male attendance to toy parties, male participants within this study were not asked if they have ever been invited to attend a party, and were therefore not asked if they’ve ever attended one nor about their levels of willingness regarding attending a party. This data reveals that a decent portion of men want or are willing to attend a sex toy party to learn more about and potentially purchase toys for them- selves and their partners. Male sex toy parties could be an effective way for more men to learn about and purchase sex toys within an educational environment. Further, all individuals should feel comfortable ex- pressing their desires with their sexual partner and be receptive to their partner’s desires, because open com- munication may reveal that they are more willing to try new sexual experiences than previously thought. One of the most prevalent findings of this study is that, among participants who report ever having expe- rienced a sexual assault, both men and women report higher rates of sex toy and sexual aid usage during mas- turbation and partnered sexual activity, but also report lower levels of comfortability doing so. This finding is directly contrary to hypotheses seven and eight, as it was expected that the trauma of sexual assault would pro- voke fear of sexual behavior among victims and would deter them from using sex toys. However, participants that have been sexually assaulted reported the highest rates of sex toy usage of all participants, this could be due to several factors. Victims of sexual assault have experienced a violation of bodily autonomy that may take a substantial amount of time to gain back, and sex toys may be one way for victims to reclaim their sex- uality. Rather than placing sexual pleasure and other sexual expectations on another person, sex toys are an efficient way to gradually increase the intensity or fre- 17 SEX TOY USE IN THE US quency of physiological sexual responses and can help to increase desire. Sexual aids, such as lubricants or vaginal dilators, could prove useful in increasing com- fortability or eliciting a sexual response among individ- uals who may or may not suffer from negative implica- tions, such as trauma or a sexual dysfunction, following a sexual assault (Kaplan, 1974; Petrak & Hedge, 2002). However, the finding that those who have ever experienced a sexual assault, despite using toys at high- er rates, also reported lower levels of comfortability during these experiences with toys was unexpected. Lower comfortability with sexual activity or material following a sexual assault is common and can be ex- pected due to the high prevalence of trauma and PTSD development after an assault (Texas A&M Health, 2019). Similarly, a common reaction to sexual assault is a change in sexual desire or activity, such as an increase in the amount of sexual or masturbatory behavior the victim engages in. Within this sample, a higher rate of sex toy usage and lower levels of comfortability were reported among those who have ever been sexually as- saulted when compared to those who have never been sexually assaulted. Higher levels of toy use, despite lower levels of comfortability using these toys, may be reflective of an attempt to regain comfortability with sexual activities through the use of sex toys. Similarly, if the sexual assault resulted in a sexual dysfunction, the use of sex toys could be a means of sexual rehabili- tation, despite conflicting levels of comfort. For exam- ple, vibrators that are smooth and shorter in length and circumference may be beneficial for patients who deal with genital, anal, or pelvic pain, or pain during sexual activity (Rullo et al., 2018). Regardless of why these rates of toy use and comfort persist among those who have ever been sexually assaulted, clinicians should recommend sex toys to clients with caution and guid- ance to help provide them with the necessary resourc- es to regain sexual comfortability and confidence. Both men and women who suffer from at least one sexual dysfunction reported lower rates of sex toy usage during masturbation and partnered sexual behavior than those who do not suffer from a sexual dysfunction. Lower levels of comfortability were also reported by the same group of participants, this could be due to various factors. Individuals who suffer from sexual dysfunctions may feel a sense of embarrassment or incompetency due to not wanting or not being able to perform sexually, and this may contribute to lower levels of comfortability using toys. Participants who reported ever experiencing a sexual dysfunction may feel as though sex toys won’t work to increase their sexual desire or functioning, and some of these partic- ipants may choose to abstain from any sexual behavior at all. Sensate focus and related treatments for sexual dysfunctions have been empirically proven to alleviate anxiety surrounding sexual activity and performance (Auteri, 2014; Masters & Johnson, 1980), which could prove useful among individuals who suffer from sexual dysfunctions that worsen with heightened anxi- ety. Further, the incorporation of sex toys into sensate focus exercises could elicit a stronger sexual response or sexual arousal than normally experienced due to increased physiological sensitivity (Rullo et al., 2020). Sensate focus allows an individual to focus purely on the physiological sensations that make them feel good, by ridding sexual behavior of expectations of orgasm, ejaculation, and pressure to please a partner. Further, it can help those with sexual dysfunctions become more comfortable with their sexual identity and to better un- derstand what types of sensations they enjoy the most. Although not part of our initial analysis, we did examine the self-perceived positive and negative effects of sex toy use among participants. There were sub- stantially more positive effects reported compared to negative effects. Examples of some positive effects of sex toy use reported by participants include: “allow- ing me to be kinky and really bond with my partner,” “butt plug helped me come out to my friends,” “rab- bit vibrator allowed for my partner to climax multiple times after I climaxed,” and “couples vibrator (like we- vibe), or bullet vibrator during intercourse, helped my partner to relax, and to climax, enhancing overall en- joyment.” There were several repeated trends among self-perceived positive effects of sex toy use. Several men reported that the use of penetrative sex toys, such as butt plugs or dildos, helped them to become more comfortable with their sexuality. Both men and women reported that the use of couples’ toys, such as a joint vibrator, has helped to increase the desirability and frequency of orgasms and strengthened the bond between partners. Many women reported that the use of vibrators and/or dildos has helped them to become more familiar with their bodies and has improved their sex life by allowing them to better learn which types of touch they prefer where. Sex toy use can have great effects on sexual functioning and the strengthening 18 FIPPEN & GAITHER aspects of education, sexuality, consent, individual and interpersonal identity, and learning which techniques can help a client maximize comfortability and pleasure. This form of sex therapy may involve sex toys, which can be utilized at the client’s request to better under- stand how these sexual aids can increase arousal, plea- sure, and intimacy alone or between partners. “Most practitioners will say their client sessions are around 30% touch and 70% non-touch - such as establishing boundaries, breathwork, nervous system regulation, embodiment techniques, and movement” (Rowett, 2020). Although met with significant resistance, sexo- logical bodywork is increasing in popularity among in- dividuals who suffer from sexual dysfunction, trauma, or assault-related issues, and shows significant promise for the future of sex therapy. However, the ability for a clinician to touch a client’s body and manipulate their genitals for purposes of tension redistribution and sexual education is currently illegal in all states except California, where only a select few individuals are licensed to practice sexological bodywork (Rowett, 2020). This is a recent modality of sex therapy and education, thus accounting for the lack of empirical research on its benefits. However, numerous female clients have been taking to the internet to blog about their positive experiences with the practice (Magner, 2017; Dubofsky, 2018). Just as vibration techniques were used as a clinical means of treating hysteria among 20th-century women (Horowitz, 2020), sex toy use in sex therapy or sexological bodywork shows promise for the treatment of sexual dysfunctions or issues surrounding sex following a sexual assault. Limitations This study had several limitations. Because data was collected in the form of an anonymous survey, the data relies on self-report measures of sexuality and sexual behavior. The survey link was posted on Reddit.com/samplesize, and thus relied on conve- nience sampling. Actual rates of comfortability may vary from those that the participants self-reported, potentially due to a desire to provide socially desir- able data or because those who use Reddit may have different inclinations to use toys. Further, there were many more women in the sample than men, and thus the data received from male participants may not be as representative of the general population. Most men within the sample (61%) reported ever having used a sex toy during masturbation, and this refutes of interpersonal relationships which is reflective of the Positive Sexuality and Positive Technology frame- works. Sex toys have only increased in popularity and functionality since they became technologically inno- vative. These toys have shown promise to increase var- ious aspects of sexuality, such as sensitivity and overall pleasure, and can help to restructure an individual’s perception of their sexuality and sexual functioning. However, there were also a considerable amount of negative self-perceived effects of sex toy use report- ed among participants. Examples of negative effects reported include “I feel that I may be more comfort- able with toys [than] the real thing sometimes,” “when I’m with a partner that traditionally doesn’t use toys, I can feel judged a bit when suggesting them,” and “felt guilty about masturbating with a toy larger than my husband’s penis.” Negative experiences, however slight, with sex toys during an intimate and vulnera- ble sexual encounter can significantly hinder one’s perception of and potential future use of sex toys and sexual behavior overall. Several women within this study reported that they felt judged or ashamed of their sex toy use, during masturbation or partnered sex, for various reasons including their partner’s per- ception of toy use, and embarrassment of requiring toys to increase sensitivity or feeling like they depend on toys for pleasure during sexual activity. Thoughtful discussion is necessary between partners for the prop- er acquisition and incorporation of sex toys into their individual or joint sex lives. Sex toys are not the main attraction of sexual activity, but are merely a means of increasing pleasure and sensitivity, and can even bring a sense of newness or excitement into partnered sex. The introduction of sex toys and sexual aids into sex therapy is both a controversial and ethical issue. An increasing number of clinicians are recommend- ing sex toys and sexual aids for individuals who suffer from sexual dysfunctions relating to sexual assault or cancer-related treatments (Bober et al., 2019), as these tools can increase sensitivity and physiological response to sexual stimulation. Aside from merely rec- ommending clients to use sex toys and sexual aids at their own discretion, many clinicians are advocating for the advancement of sex therapy to include sexolog- ical bodywork, which is a form of educational sex ther- apy that potentially allows for one-way sensual touch between the clinician and the client, although not al- ways (Rowett, 2020). Sexological bodywork involves 19 SEX TOY USE IN THE US the assumed belief that men are more hesitant to use sex toys. However, due to the limited number of men within the sample, actual statistics may vary. The present study was forced to exclude partici- pants from the analysis who identified as anything other than a man or woman. 3.7% of the sample (n = 12) self-identified as an “other” gender, but because this sample was so small they were excluded from the study. Future research could focus on other-gendered participants to better understand the prevalence and characteristics of their sex toy use. As discussed by Fahs and Swank (2013), nonheterosexual and oth- er-gendered individuals may not emphasize phallo- centrism and male dominance during sexual activity with a partner, and may feel more inclined to use sex toys as a means of campy and subversive pleasure. Because this survey and individual items were created by the researchers, as well as borrowed from the work of Döring and Poeschl (2020), there are no psychometric properties to report. However, using standardized measures to assess prevalence, com- fortability, and willingness regarding sex toys could have provided stronger research support for this study. Finally, the participants of this study were large- ly young white college students. Older individu- als or individuals without technological access may not have been able to access the survey link because it was posted to Reddit and Ball State University’s Communication page. Our study’s lack of diver- sity could be expanded upon in future research, emphasizing minority or older cohort sex toy use. Implications for Future Research This study could be expanded to include a larg- er minority sample, including sexual, gendered, and racial minorities, to better understand their sex toy use and how they became socialized to utilize these toys. Further, future research could focus on an old- er cohort sample, as the rate of sexual dysfunctions tends to increase exponentially with age. Sex toys could elicit heightened sensitivity or arousal from individuals who suffer from age-related sexual dys- functions and could further help connect partners. With respect to sexual dysfunctions, future re- search could examine how sex toys and sexual aids can be incorporated into sex therapy to help increase physiological responses following a sexual assault. Sex toys could be incorporated into sensate focus exercises to increase sensitivity and pleasure for the individual, allowing them to focus solely on the pleasurable sensations. To combat the physiological complica- tions of sexual dysfunction, clinical psychologists may recommend or prescribe various sexual aids to use either alone or with a partner. These sexu- al aids may include vibrators, dilators, Kegel balls, and dildos, and successive approximations may be utilized until the client gradually becomes more comfortable with sensual touching, and eventual- ly, sexual intercourse. However, the introduction of sex toys into sex therapy recommendations for victims of sexual assault should be predated with caution and a thoughtful discussion between the client and the clinician, as some of these individu- als may suffer from PTSD (Yu Yip & Yuen, 2010). Conclusion The findings of this study indicate that a sub- stantial number of American adults have ever used a sex toy during solo or partnered sex. Among wom- en, the most used sex toys during masturbation in- cluded toys designed for the stimulation of the vagi- na and vulva, lubricants, and erotic lingerie. Among men, the most used sex toys and sexual aids during masturbation included lubricants, toys designed for the stimulation of the penis and testicles (see Table 2), and toys designed for the stimulation of the vagi- na and vulva. Men and women were about equally likely to have used lubricants, remedies for enhanc- ing arousal, toys designed for the stimulation of the penis and testicles, and toys for bondage and S&M during partnered sexual activity. Similarly, among participants who have never used a sex toy, a signif- icant portion of this subsample would be willing to incorporate sexual aids into solo or partnered sexual behavior in the future. Nearly an identical percentage of men and women who have been sex- ually assaulted reported using a sex toy during mas- turbation, and men reported slightly higher rates of toy use during masturbation compared to women. However, both men and women who have been sex- ually assaulted reported lower levels of comfortabil- ity during their previous experiences using sex toys. Future research could explore how sex toys could be utilized as a method of treatment for sexual dys- functions or implications following a sexual assault. 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