Perception of vulnerability in young females’ experiences of oral sex: Findings from the focus group discussions

Abstract The current study examined the issue of vulnerability in oral sex as perceived by female university students. Five focus group discussions were conducted with an aim to look at different sides of young females’ experiences of fellatio and cunnilingus. The study revealed that vulnerability in oral sex was perceived by females as physical and emotional, and was further amplified by sociocultural and gender power pressures. Perception of vulnerability reflected the transition stage in females’ efforts to resolve gender-structured oral sex dilemma. Findings have implications for educators and healthcare providers who aim to protect young females’ physical and mental health.


Introduction
The results of the UK national surveys on sexual behaviour (McManus et al., 2004;Mercer et al., 2009;Wellings et al., 2001) demonstrated that oral sex is becoming increasingly popular amongst adolescents and young adults. Nevertheless, the amount of research on their oral sex experiences is ABOUT THE AUTHOR Elena Sovetkina obtained her PhD (2016) from the University of Bath, UK. She is stage 1 health psychologist and an experienced health counsellor. Her research interests include selfcontrol and risk-taking behaviour, health-related behaviour and motivation, social and cultural contexts of sexual activity of young people. Specifically, she is interested in medical sociology, epidemiology and in research exploring the link between oral sex behaviour and HPV-related oropharyngael cancer. The research reported in this paper was a part of her PhD project on the role of self-control in young people's oral sex behaviour and psychological well-being.

PUBLIC INTEREST STATEMENT
High level of young people involvement in oral sex is becoming a reality of modern life. This study aims to look at female university students' experiences of oral sex through their own lenses to explore what fuels their perception of vulnerability in oral sex. Five focus group discussions conducted for this study revealed that this vulnerability was perceived by female students as physical and emotional. They reported that their experiences of oral sex were affected on personal and relationship levels. Body image self-consciousness, lack of self-confidence contributed to the impact of media pressure regulating their physical appearance and performance in oral sex. This pressure was perceived by them directly and through males' behaviour and expectations. Young females' perception of vulnerability was further amplified by sociocultural gender roles stereotypes and reflected the transition stage in their efforts to adjust to the realities of gender-structured adults' sexual life. relatively sparse and represented by mostly quantitative studies. The current paper aims to address this gap in knowledge by exploring the young females' oral sex experiences qualitatively.
Psychology literature indicates that majority of adolescents got engaged in oral sex because they perceive oral sex as a recreational activity that provide them with an opportunity for risk-free sex, in terms of health, social and emotional consequences (Bersamin, Walker, Waiters, Fisher, & Grube, 2005;Kaestle & Halpern, 2007;Lindberg, Jones, & Santelli, 2008;McKay, 2004;Prinstein, Meade, & Cohen, 2003;Uecker, Angotti, & Regnerus, 2008). Research on hooking up, as a distinct social form of behaviour on college campuses in the USA, revealed that parental discouragement of relationships emerged as an important predictor for oral sex hook-ups on college campuses (e.g. Fielder & Carey, 2010;Paul, McManus, & Hayes, 2000). It also appeared that parental discouragement also predicted the number of oral sex partners amongst college male students: the stronger was students' perception of parental discouragement of relationships, the greater the number of oral sex partners they reported (Owen & Fincham, 2011).

Polarity of oral sex experiences
Decades of research on sexual behaviour has revealed that oral sex can hold different meanings for males and females (e.g. Boyce et al., 2006;Ott, Millstein, Ofner, & Halpern-Felsher, 2006;Patrick & Lee, 2010) and can be associated with both positive and negative emotional outcomes (Chambers, 2007;Malacad & Hess, 2010). These outcomes have been linked to the motives behind young people's engagement in sexual activity: the approach motives and intrinsic motivation (e.g. seeking physical pleasure, enhanced relationship intimacy and shared pleasure) were associated with more positive outcomes, while avoidance motives and extrinsic motivation (e.g. preventing relationship conflict or partner disappointment, coping with negative emotions, responding to external pressures) were associated with more negative outcomes (e.g. Ott et al., 2006;Patrick & Lee, 2010). As young females were found to be more influenced by social and relationship pressure regarding their engagement in sex than young males, the association between extrinsic motives and their sexual behaviour proposed to be especially significant for them (e.g. Schatzel-Murphy, Harris, Knight, & Milburn, 2009;Tolman, 2012).
As attributed to oral sex, positive emotional outcomes, for both young males and females, were associated with oral sex in love or in relationships. They were grouped around the concept of mutual pleasure for both recipient and performer. Practicing oral sex in casual, non-committed relationships tend to produce a completely different spectre of emotional outcomes, which differ by gender. As a rule, young males reported being more satisfied with themselves as a result of having casual oral sex, as this gained them popularity amongst their peers, whereas young females were more likely than male adolescents to report negative social and emotional consequences from engagement in casual sex. In contrast to male adolescents, young females practising casual oral sex often felt as being used by their sexual partners; they also reported less pleasure and less satisfaction, lower sexual self-esteem, feelings of anxiety and being guilty for their sexual behaviour (e.g. Brady & Halpern-Felsher, 2007;Halpern-Felsher, Cornell, Kropp, & Tschann, 2005;Sanchez, Moss-Racusin, Phelan, & Crocker, 2011).
Negative or positive consequences of young females' oral sex experiences appeared to vary for cunnilingus and fellatio. Bay-Cheng and Fava's study (2011) found a relation between initiation of cunnilingus and sexual motives: females who initiated cunnilingus at younger ages demonstrated higher levels of engaging in sexual intercourse for personal gratification and in order to feel assertive, agentic and skilful. Amongst young women with cunnilingus experience, more sexually assertive young women (i.e. more able to advocate for their own sexual interests) also appeared to have more lifetime cunnilingus partners.
Contrary to cunnilingus experience, narratives of girls' fellatio experiences consist of talks on coercion, shame, guilt and ignorance (e.g. Tolman, Futch, & Burns, 2009). Research on early sexual activity suggested that higher levels of interpersonal sensitivity in adolescent girls (i.e. feelings of personal inadequacy and devalued self-worth) was related to initiating fellatio at younger age, and early experiences of fellatio increased their vulnerability in other domains and compromised their psychological functioning (e.g. Kaltiala-Heino, Kosunen, & Rimpelä, 2003;Meier, 2007).
It was also suggested that young females' lack of confidence and low self-esteem, as related to oral sex behaviour, may hold a potential link to the wide-spread in Western culture "standards" of females' bodily appearance, reflecting in huge media pressure for females to be thin (e.g. Wiederman, 2000). The range of physical and behavioural problems, associated with this sociocultural pressure, includes disordered eating, unbalanced diet regimes and increase in females' body image concerns and in body-shaping behaviours (e.g. Dittmar, 2005). In context of sexual behaviour, body image self-consciousness found to be concurrent with low sexual self-esteem, and subsequently, difficulties in negotiating sexual behaviour and, as a result, in increased depression in young females (e.g. Cash & Pruzinsky, 2002;Tiggemann, 2005;Wiederman & Hurst, 1998). It is highly possible that body image self-consciousness could be even more salient feature of females' experiences of oral sex.
Finally, the evidence from qualitative studies on sexuality perception indicates that negative or positive aspects of young females' oral sex experiences are likely to mirror sociocultural representations of oral sex that exist within culture and society, and are based on a combination of personal, relationship and social factors (Braun & Clarke, 2006).

Intersection of gender and class in sexual behaviour
Within contemporary gender theory's construct of young adulthood sexuality, both negative and positive psychological health outcomes of sexual behaviour are often considered through the concept of gender and in context of sexual interaction.
Research on gender and power arrangements in society suggested that gender beliefs, as a social structure, are embedded at multiple levels of society (Connell, 1987;Ridgeway & Correll, 2004;Sewell, 1992), including perceptions of individual selves, sociocultural organisational arrangements, and social and sexual interactions. According to this perspective, the power of gender beliefs influences individuals by "programming" the ways of how they see them in social and sexual interactions and by holding others accountable to this perception (e.g. Ridgeway, 2009).
In sexual behaviour, gender beliefs generated a powerful set of public beliefs about women's sexuality and sexual double standards: males are expected to desire and pursue sexual behaviour regardless of context, whereas female are expected to avoid casual sex and have sex only in love and in relationships (Risman & Schwartz, 2002). As part of their gender socialisation, adolescent girls are taught to be passive and to refrain from exhibition of their own sexual desire; they also expected to manage social pressure regarding their sexuality from their peer group (Impett, Schooler, & Tolman, 2006;Tolman, Striepe, & Harmon, 2003).
In oral sex, gender beliefs situate males as mainly recipients and females as mainly performers of oral sex on males. Sexual double standards in oral sex are further stretched to the societal and personal acceptance of appropriateness different types of oral sex for each gender. Any experiences of oral sex are universally seen to be appropriate to and benefit to young males. Conversely, young females who engaged in oral sex with males are very often stigmatised as "sluts" by their female peers for giving oral sex to males.
Merging together two systems of inequality in the sexual area, it was argued that like gender, social class beliefs can also possess a power to structure social and personal beliefs about appropriate sexual behaviour. In modern western society, the self-development imperative (i.e. social expectation to defer family formation until the later age to focus on education and career investment) makes casual sexual interactions on university campuses (hooking up) more appealing life-stage sexual activity for both genders than committed relationships (e.g. Arnett, 2004;Rosenfeld, 2007).
For young females, this intersection of gender and social class in area of sexual behaviour may produce a conflict between gendered beliefs (that they should avoid casual sex outside committed relationships) and social class beliefs (that they should delay relationship while pursuing educational and career goals) (Hamilton & Armstrong, 2009). This structural contradiction resulted in the rise of a strategic approach to sex and relationship, which provided female students with ambivalent sexual experiences. The necessity to utilise university's hook-up culture as a delay strategy made young females to face a challenge to elaborate their own ways of resolving this structural dilemma for themselves. As oral sex seems to be a part of this sexual hook-up's university culture, positive or negative emotions, accompanying young females' experiences of oral sex, can be seen as the indication of how well they can manoeuvre between structures constraining their sexual experiences in a complex arena of contemporary sexual behaviour, and how well they manage to establish themselves within this culture.

The current study
In the current study, we were interested in the further ways of how intersection of structured gender and class beliefs can guide and influence oral sex experiences of females' university students. Thus, our investigation was designed to look at different sides of young females' perception of their oral sex experiences through their own lenses, and was aimed to elucidate how gender and power arrangements in society could affect oral sex interactions between young heterosexual males and females.
By initiating discussions in focus groups about both fellatio and cunnilingus experiences and listening to our respondents' voices, we sought our female participants to elaborate their own understanding of power in oral sex on different structural levels (the individual, interactional, social environmental), and then identify any possible emotional and physical issues associated with their oral sex experiences, at each level. We also asked them to provide the possible explanations about the nature of their feelings. We wanted to know when, how and why any of these feelings get attached to their oral sex experiences and to which of their own personal characteristics, relationship interactions and characteristics of their social environment they were attributed to by our female respondents. Equally, we wanted to hear how they manage to resolve their oral sexual dilemmas, and how they utilise their structural positioning in resolving these dilemmas.
Although the use of focus groups for such a sensitive topic as oral sex experiences may have the potential to affect participants' privacy and to decrease the quality of disclosure obtained from the focus group members, the interactive nature of group discussion can provide the conditions under which female participants feel comfortable to discuss some most intimate and troubling them sexual issues and sexual experiences of their lives, and may enhance the quality of data obtained (e.g. Frith, 2000).
The choice of focus group for this study over interviewing each of young women individually provided us with some important advantages. Focus group discussions allow us to undercover and to explore various definitions and understandings of oral sex held by participants; to collect and to observe interactions between participants during discussion about oral sex, and to study how the consensus is achieved or conflict handled within a group setting (e.g. Morgan & Spanish, 1984). This method also offered us the opportunity to clarify questions and minimise misunderstandings, encourage females to address sensitive issue of engagement in oral sex in a supportive environment and allow collecting the data that provides explanations as well as descriptions (e.g. Krueger, 1998;Zeller, 1993).

Procedures
The study was conducted as a part of larger project on oral sex behaviour in the one of the major universities on the South-West of the United Kingdom. Participation in the focus groups was on a volunteer basis and strictly anonymous. All participants were recruited by online advertising on internal students' university website, this method was chosen for ease of contact the population of interest. A total of five female focus groups were run; the smallest group comprised from three participants, the largest group-from six participants. To promote valuable discussion, groups were organised based on different levels of oral sex experience and the type of feedback on this experience, according to information from the demographic questionnaires. The focus groups took place in private non-formal locations at the university site so that participants feel more comfortable in providing their in-depth opinions.
All participants received the information sheet about the study and completed a consent form. Participants were given clear information about their right to withdraw from participating in the focus group at any time before the data will be processed and anonymised. The focus group discussions were led by a female facilitator (the researcher), and lasted from 90 min to 2 h, and were audio-taped and transcribed. Each participant received £10 for her participation.
At the beginning of the session the researcher set up the ground rules for the discussion and gave the instructions to participants. To encourage focus group discussion, stimulus material was prepared which consisted of a short presentation with a selection of anonymous students' responses to the previous researchers' oral sex survey questions about their reasons for being involved in oral sex. The researcher then asked participants to explicate how these came to be, or what the stories may be behind these data. In accordance with the concept of collective interrogations (i.e. exploration of the intellectual and political possibilities of focus groups), the researcher let the subject of oral sex to travel between personal experiences and combined imagination. This method allows participants to be active subjects of research and provides them with the opportunity to make inquiry and speak for ambiguity.

Data analysis
The research used a narrative approach and thematic analysis (Hollway & Jefferson, 2000) to analyse data from this focus groups. The researcher and the second coder read through the transcripts from each focus group separately. In accordance with methodological recommendations for qualitative research (e.g. Denzin & Lincoln, 2000) at the first stage the researcher conducted line-by-line open coding in order to establish the main themes and sub-themes. Then the researcher reviewed these preliminary coding themes and re-organised those sub-themes that were less meaningful to make them thematically coherent ( Figure 1).

Figure 1. Final thematic map, showing final two main themes.
At the second stage, the researcher and second coder reviewed and revised the initial coding scheme. Both the researcher and second coder coded each focus group transcript individually, and then compared their results, gradually reaching agreement regarding the meaning of individual codes, their definitions and relation to one another, and also their applications to the coding themes (Table 1).
Based on what had been heard in each group, the researcher and the second coder designed a coding frame for the transcripts using themes of research interest. Once agreement was reached, the researcher revisited the transcripts and coded them using the final coding scheme. The second coder coded two out of five transcripts randomly chosen by the researcher. During this process, the researcher and second coder periodically discussed their coding strategy to ensure coding convergence on those transcripts that both of them had coded. Reliability was calculated amongst the two coders. In the final stage, the researcher matched the main themes and sub-themes across each group and separated them on the basis of whether they occurred in the story about oral sex experience or in general discussion.
In addition to coding themes, the researcher compared the course of discussion across focus groups. The format of the focus group interview research allowed participants to freely interact with each other in the course of discussion, questioning and challenging one another thereby deepening individual understandings and broadening meanings (Wilkinson, 1998).

Characteristics of the study sample
In total, 24 female university students participated in the focus groups. Their age varied from 18 to 22 (M Age = 20). About 87.5% of participants (N = 21) identified themselves as white. Approximately 17% (N = 4) of female students reported to have an extensive experience of oral sex, while the remaining 83% (N = 20) reported rather moderate experience. Half of the participants indicated that they have performed oral sex in and outside relationships; about 42% of females (N = 10) said that they had oral sex only in relationships, while 8% (N = 2) had it solely outside relationships. Half of the female students reported to have a positive experience of oral sex, 25% (N = 6) had had neutral experiences, 21% (N = 5) could remember a mixture of experiences and 4% (N = 1) of females reported having a negative experience of oral sex.

Perception of vulnerability in oral sex: Power of socially arranged gender role's stereotypes and behaviour
The issue of the different purpose and meanings of oral sex inside and outside relationships was clearly made in each of the focus groups. While discussions developed, a clear distinction between giving and receiving oral sex was identified by all female respondents. The nature of this distinction was in females' personal perception of vulnerability in fellatio and in cunnilingus.
Females defined their vulnerability in oral sex as physical and emotional and related them to external (i.e. partners' characteristics) and internal (females' own characteristics) factors. External factors were associated with females' physical vulnerability in oral sex and were closely connected to an experience of distress from males' attempts to take physical control during fellatio and a physical pain/discomfort during cunnilingus. Internal factors were associated with females' emotional (psychological) vulnerability and were closely connected to the experience of distress about the perception of females' own physical appearance, and their perception of males taking control over the relationships. On many occasions physical vulnerability was accompanied by emotional vulnerability, as external and internal factors appeared to be inter-connected. Perception of physical vulnerability was organised around socially accepted stereotypes of appropriate gender roles and gender behaviour. It was related to males' attempts to take physical control during fellatio and a physical discomfort or pain during cunnilingus. Physical vulnerability was accompanied by females' feelings of emotional distress.
The males' tendency to take physical control during fellatio was perceived by our respondents as males' efforts to change the balance of power in oral sex in their own favour and attributed to the very nature of males' perception of sexuality: Actually, my boyfriend told me that he kind of likes when I am a bit uncomfortable, and I had heard that from a lot of guys. It's kind of power thing but he didn't really mean that he wants to hurt me. I think that they just find it sexy when you are a bit uncomfortable. I think that it just has to do with their nature: they want to feel like they are powerful (FG4).
Participant 4: I think that men do feel empowerment when they are having oral sex with you, because they can move your head and stuff like that (FG3).
Participant 1: I hate if they start, like, thrusting it into your mouth and when they try to take control of the situation. I don't like that at all, its like, "No, I am in control!" (FG2).
Amongst the most unpleasant things in fellatio, perceived as males taking physical control over sexual activity, female students nominated males ejaculating in their mouth and expecting them to swallow their sperm, and physically pushing their heads down.
Female students emphasised that majority of boys were obtaining knowledge about oral sex from watching porn on the Internet:

Participant 1:
Boys seeing porn on the internet and stuff and thinking really that is what sex is, but I suppose it's kind of like, I see it and I want to try it and stuff (PG1).
They regretted that the quality of this information from porn movies put young females in a very vulnerable position.
The experience of physical pain during cunnilingus was perceived by females' respondents as a sign of males' non-maturity and was attributed to the influence of porn.
The porn ideas about males' understanding of good cunnilingus performance, obtained from focus group discussions, can be divided on "the myths" how to give "good" oral sex to girls and on the myths that girls can have orgasm from oral sex numerous times.
The myths about the "technical" side of cunnilingus were discussed in accounts of females' experiences of physical pain and discomfort from this sexual activity. In many cases, the physical discomfort from cunnilingus was accompanied by psychological distress.

Participant 3:
When I was 17 or 18, I went out with an idiot who thought that porn was normal sex. He had never done anything sexual, even with regards to oral sex and he had given me oral sex. It felt so weird and it was exactly like porn, which is not what you are supposed to do. It felt weird and painful for me because, as I said, I am really sensitive down there and he was being really rough, he was sorry for being rough but he was sucking on my vagina, it was not pleasurable, it was rather painful, and since he was my friend, but not in that bond emotionally, I did not feel comfortable enough to say, like, hey, what are you doing? But it was a really negative experience, because it was exactly as to what you would see in a porn movie (FG3).
The myths that girls can have orgasm from cunnilingus numerous times were also discussed in the light of its psychological pressure for females: Participant 3: From oral sex I can only barely orgasm, because I do enjoy it, but it's just not that awesome for me. So, for me it's actually a big accomplishment to orgasm from oral sex. But in porn movie they orgasm like 5 times from it, and I think that is what younger boys should think that it's supposed to be like that.
Participant 1: And that puts pressure on women to orgasm like 10 times (FG4).
Our respondents argued that this pressure led them to worry about not meeting "the standards" and feeling guilty of not performing like in porn movies, and such as not fulfilling boys' expectations. At this point, perceptions of physical and psychological vulnerability were inter-connected. Participant 3: I find the same thing with the pressure to orgasm, I do feel that pressure, because if the guy is down there for like 10 min and I am still not close to it, just feels like selfish, and then it feels like I am taking advantage of him, and I worry that they might feel inadequate down there (FG5).
These issues were so troublesome for girls that one of them finally noted that she could see the "hidden" boys' control over girls in these expectations: "it's kind of like he is controlling you in a way because you worry about it" (PG1).

The theme of emotional vulnerability in oral sex and the nature of psychological distress attached to it
Perception of emotional vulnerability was more complex. In first instance, it was organised around socially accepted stereotypes about females' physical appearance and, in this way, was related to females' problems with their self-esteem and sexual self-efficacy.
More deeply, females' emotional vulnerability reflected their difficulties in utilising their structural positioning as the means of resolving oral sex dilemma for themselves. The main sub-themes here were females' anxiety about not meeting males' sexual standards and their concerns of males' controlling and dominating them in relationship.
The general statement reflecting the issue of body image concerns, as it was expressed by one of our respondents, is provided below: Talking about body image self-consciousness in context of females' experiences of cunnilingus, participants discussed the social pressure from media and porn in dictating young females the standards of their physical appearance. Participants noted that this made them feel self-conscious and reflect upon their body image satisfaction.

Participant 4:
We have to be clean and all that, our legs and underarms. So, that has become another fact we have to worry about, because with some guys, that like this kind of thing, it's expected amongst all girls. There is more of the pressure, like on top of being pretty and skinny, to worry about.
Participant 6: I think that it makes you feel more like self-conscious about yourself and, I think, a lot of women have this sort of an illusional power of men.
Participant 1: You have to think about how you look, not just that area, but like flabby tummies and everything else, so it's not just that but it's the image on the whole. Participant 2: I think that women are worried because they know that men watch a lot of porn and that, and women in porn have these designer vaginas, and I think that men expect that from us (FG5).
These body image concerns were agreed to play a major role in females' perception of vulnerability in cunnilingus. The best illustrations of this were found in talks about females' perception of being not physically fit enough (i.e. issue related to having cellulite etc.) and having body disfigurations.
Participant 1: um something that I could add to the whole confidence issue that we had been talking about … on the left inside lip of my vagina I have got a birth mark which is basically its kind of blueish and its just a bit bumpy but um I remember that at one point I was so uncomfortable with myself just because I was like, oh my gosh, guys are going to see, that what are they going to think? Are they going to think that it's some kind of STD or whatever? I have been scared that people think that I am not clean, not in the sense that I don't wash, but in the sense like omg is that an STD? When its not, is just a birth mark (FG2).
The discussion about body image concerns, as applied to cunnilingus, made participants talk about such types of psychological vulnerability, as self-exposure and fear of judgement on the basis of their body image flaws: Participant 1: Yeah, cause women are quite worried on men picking up on any of their flaws and, you know, she might have a bit of cellulite or, you know, maybe there is the whole thing about men don't liking pubic hair, as well, and that is whole another issue for women to deal with. Maybe women just feel worried about that men are going to see all of me now rather than just, you know, my personality, they are going to see everything.
Participant 2: I think because it is more intimate with oral, so they feel a lot more exposed so if you got any fears like that. But then again, that is probably also disturbance from body image problems from the media and pressure? (FG5) Participants explicitly linked body image worries to the issue of "self-confidence" that they consider to be very important for both involvement in oral sex with males and declining the offer of oral sex from males.
They clearly attributed the lack of confidence to resist relationship pressure to get involved in oral sex to the potential danger for them to be controlled and dominated in relationships by males.

Participant 3:
It would affect the rest of your life as well, so when they are like pressuring you to have oral sex and you don't want to, you would start thinking about other things that they do, like, if you both go out to dinner, he gets to choose what you eat and, like, when you are watching TV then he is the one who gets to choose, it just shows the way the pressure is more dominant! (PG1) Participant 1: I think that is a point of concern because I feel like giving oral sex, that is the time that they have the power in the relationship sexually and I feel like there needs to be an even power exchange, umm, in the relationship. So, that is if that is taken away, that is a bit worrying.
Participant 4: Yeah, that is sort of like a slipperly slope really (FG5).

The challenge of overcoming vulnerability in oral sex: personal confidence to manipulate gender power
The issue of "self-confidence" appeared to have an outer lining for young females as related to their experience of both fellatio and cunnilingus, as they linked it with perception of males' physical and emotional control over them and over relationships. This, in turn, led them to experience a psychological distress attached to the perception of vulnerability in oral sex. The critical point here appeared to be females' capacity to say NO to unwanted oral sex, if a female liked the partner and wanted to have a relationship with him.
The females' opinions of how to overcome this challenge differentiated: Opinion 1: Well, with my boyfriend at the beginning we did not have sex with each other, it was literally just foreplay and stuff and there were some times when I was like "I don't want to do it", but I really couldn't just, like, say No because then what else were we gonna do? It would just completely ruin the atmosphere, and the guy might get really offended and annoyed, which is why in the early stages of the relationship I just didn't say NO, like, how would he react if I say no? So, I just made the best effort not to say NO and just go with the flow (Participant 4, PG1).
Opinion 2: It depends on your confidence really, like if the guy is putting pressure on you to do something, then it is not ok, you should not be with someone whom makes you feel like that, and there are a lot of people in the world whom would feel pressured in all sorts of relationships, and they feel like they are just doing what is expected of them, but I think, it is just that confidence thing, like if you feel pressured then don't do it! (Participant 4, FG3).
In attempt to somehow counterbalance this pressure and emotionally to ease their psychological vulnerability, respondents across all groups promoted the idea that performing oral sex can give them some kind of manipulative power over males. This type of power was referred to as taking control over males' pleasure and orgasm; using oral sex to keep hold on their boyfriend, and using oral sex to get what they wanted or to impress their partner in order to be liked or loved.
The females' power to take control over boys' pleasure/orgasm was transformed into emotional satisfaction that girls gained from performing both fellatio and cunnilingus. Interestingly, the currents within this link seem to operate in two different ways: in performing fellatio girls felt powerful by making boys to orgasm, and in cunnilingus while faking orgasm girls felt powerful by making boys to believe in their power to make girls to orgasm.
Participant 1: I find that in the past I had been using oral sex to get something that I wanted and for getting men to like me not always but, I guess, it was a tool of manipulation for me. It's, um, if I am see someone and I quite like them, then I might go down on them because I want to maybe impress them or show that I am giving or a good lover? Or, yeah, I think that is probably what it is, I suppose, it is a power thing, you know, although you might be physically beneath them, you are kind of looking up at them, you have complete control of their genitals and you have control over their arousal, you know they are getting aroused over what you are doing, and it feels nice to know that. Even if you don't like them or if they don't like you, they are still being aroused by you (FG4).

Participant 2:
It's kind of a curse really … you know that you are not going to get there … and feel like, like to stop, it's not going to happen, so you try to consider that, so it's just like to spare us both, so that is a bit of power as well, in a way, I think, because you are faking it to get some fun, so you are making them think otherwise. Yeah, so, that is the power, that one day you can be like "You know all them times? I faked it!" [Laughter amongst participants], so that is kind of power, I guess, isn't it? (FG1) While the experiences of using oral sex as the tool of manipulation with the purpose of getting some benefits or to be liked/loved were associated with engagement in both fellatio and cunnilingus, the experiences of engagement in oral sex with the aim of keeping a hold on boyfriends or to make a relationship work were strongly associated with fellatio.
Participant 3: I think that it's again a power thing, and I know that a lot of women actually use oral sex as a way to keep hold of their boyfriend, and not break up with them. In both cases, while discussing these experiences, participants demonstrated a full awareness of what they were doing and why they were doing this, and applied explicitly the term of "power" to such actions and situations.
In comparison with the experiences of females engaging in both fellatio and cunnilingus with the aim to exercise their power over male's pleasure and getting emotional satisfaction for themselves, the experiences of fellatio with the aim to keep relationship going were rather associated with females' perception of being powerless and insecurity in sexual relationship, and demonstrated their vulnerability in current relationship that appeared to come to life through the vehicle of oral sex. This conclusion was supported by the final comment made by one of the participants: Participant 3: I think, if he does not want to be with you and you are only using oral sex as a way to keep hold of him, then you are only abusing yourself not them and that is only you, you are the only person that is going to be affected at the end, if that makes sense? (FG4)

Discussion
This focus group study explored female students' oral experiences and the ways of how power arrangements in society can influence the interactions during oral sex between young heterosexual male and female university students. We used a narrative approach and thematic analysis to uncover young females' strategies of making sense of their oral sex experiences, with the purpose to investigate how these experiences may affect their perception of oral sex.

The issue of power and vulnerability in oral sex
In general, all participants agreed that both males and females hold a particular power in oral sex interactions. Males' power was referred to as their ability to make females give them oral sex, to control females' sexuality and to make females worry about their sexual performance and their desirability for them. Females' power in oral sex was defined as controlling males' orgasms, and using oral sex performance as a tool of manipulating men. Females' stories varied depending on the purpose of this manipulation. One of the main aims of such manipulation, spoken about quite openly by female participants, was "to be liked by their partner", to be "different" (from other girls) and to be "special to the partner". At this point females' accounts of power and vulnerability were mutually dependent.
Our findings indicated that the stories behind this accounts of power and vulnerability were multilayered.
On the upper layer, they were grounded in the very way of how modern society coined the whole issue of oral sex, and reflected gender and power arrangements in sexual behaviour. Focus groups showed that this actual or perceived vulnerability was inter-connected with different types of pressures placed on young females. Firstly, it was the pressure from societal norms and societal expectations related to their sexual behaviour in general and to their oral sex behaviour in particular. Young females reported to be pressurised by societal expectation to engage in oral sex and to perform both types of oral sex. Secondly, this pressure was identified as the pressure associated with dynamic of negotiating sexual behaviour with their partners within sexual interactions or relationships, accounting for the attitudes, standards and desirable/non-desirable outcomes for both parties. On the individual level, young females reported that they felt pressurised by males not only on the basis of their judgements about their oral sex performance but also on the basis of their own ability to get an orgasm from oral sex. Finally, for some of them, these pressures were reported to further transform into the feelings of being controlled by males, as they made them worry about their sexual performance.
On the lower layer, young females perceived their vulnerability in oral sex as physical and emotional, and these two appeared to co-exist at the same time and for the same person. Physical vulnerability was referred to as a partner's level of knowledge of physiology in general and females' physiology in particular, and was closely associated with a dangerous tendency amongst young males to have porn movies as a source of their sex education. Emotional vulnerability referred to females' individual body image self-consciousness, their sexual self-esteem and their anxiety about being emotionally and physically controlled in sex by males. In many cases physical discomfort was found to be accompanied by emotional distress.

The issue of body image concerns in oral sex
Body image-related concerns were in the heart of young females' worries about engagement in oral sex. Most importantly, these concerns were also grounded in the same multileveled gender and sociocultural structure. The concerns of looking not fit/good enough and a fear to be negatively judged by their male partners on the basic of their body image flaws appeared to make girls feel extremely vulnerable in both a physical and emotional sense, especially at the beginning of the relationship. Physical vulnerability was referred to as not being fit enough physically (e.g. flabby tammy, skinny legs) and having some physical disfigurations (e.g. skin problems, birth marks); whereas emotional vulnerability was more associated with not looking pretty enough to a partner during sex (e.g. under a particular angle and in a particular position). Applied to the whole nature of oral sex, body image concerns were exacerbated by sociocultural pressure to look pretty and skinny and to perform in oral sex as porn star models.
One the one hand, the findings that many of our participants, who already looked skinny according to the modern fashion, were talking about their body image self-consciousness during oral sex may be considered as a sign of their personal lack of sexual self-efficacy that has little to do with society standards to be thin. This suggestion was supported by findings from Wiederman's (2000) study where young women who viewed themselves as good sex partner were found to be least concerned about their bodily appearance during physical intimacy.
On the other hand, it can indicate that young females with higher body image self-consciousness but similarly sized with their peers may have developed and applied to themselves the unrealistic standards for female attractiveness, taken from the popular media and porn. Therefore, their greater body image self-consciousness during oral sex could be a result of such extreme views on their bodily appearance and attractiveness (Fredrickson & Roberts, 1997;McKinley & Hyde, 1996).
Finally, although none of focus group participants revealed that body image issues have stopped them from performing fellatio, experiences of cunnilingus was much strongly affected by young females' body image self-consciousness. A fruitful path for future research will be in exploring the impact of females' body image concerns and the frequency of their habitual negative body image thinking on their engagement in cunnilingus and its emotional and mental health consequences.

The issue of personal confidence to overcome vulnerability in oral sex
The discourse of confidence was the thread that linked all participants' talk about their oral sex experiences. All of them emphasised the role of confidence and sexual self-efficacy in females' vulnerability attached to oral sex practice. Participants referred these confidence and sexual self-efficacy to females' ability to say "NO" to unwanted oral sex offers in the service of preserving relationship and to express their own desires to their partner. The discourse of "inauthenticity in relationship" (e.g. Tolman, Impett, Tracy, & Michael, 2006), known from a previous research, was clearly presented in stories of female students who find it difficult to communicate their own desires and therefore, who were willing "to sacrifice their sexual health in the service of preserving relationships" (Impett et al., 2006, p. 133). Thus, our findings were in accordance with findings from previous studies on self-efficacy in sexual relationship (e.g. Impett & Peplau, 2003;Impett et al., 2006). Although female participants particularly emphasised the importance of "confidence" in oral sex, majority of them talked about this issue in the manner which allow to suggest that they have already managed to sort it out for themselves, and mentioned it rather in context of some of their friends' current experiences.
At the same time, we heard the stories of very confident young females who appeared to be satisfied with performing both fellatio and cunnilingus. Some of them reported to give oral sex in order "to please their partner", and expressed a feeling of pride about their ability to do this to satisfy their men. Some of them considered their engagement in oral sex as a personal achievement, and clearly evaluated it as a personal success accompanied by the positive emotions. The positive emotional feelings were normally applied to female students' performance of fellatio in trustful and committed relationship.
The importance of females' confidence to manipulate power arrangements and thus, to overcome their personal vulnerability in oral sex was particularly salient in the discourse of "desire". In this study we had a single narrative of pure "desire" related to oral sex, from female participant who openly declared that she likes to give oral sex because of her personal perception of giving oral sex to men as an extremely submissive and arousing experience. This narrative was rather the exception than a norm for our focus groups. This female student appeared to sound like a woman who likes her looks and who was completely satisfied with her appearance and, subsequently, as a woman who feels particularly efficacious within an oral sex situation and when her body displayed, a situation where women are typically afford less power than men. This narrative can be interpreted as an example of the importance of accepting stereotypical gender roles in sexual behaviour for females' sexual desire and satisfaction. This story, taken in as a whole, also provided a strong link between female's body image satisfaction and their confidence and self-efficacy in oral sex.
Although the discourse of desire and pleasure was present in females' narratives about oral sex, this discourse was relatively rare. Typically, females reported positive emotional feelings from satisfying their male partners or overcoming the challenge of performing fellatio or cunnilingus rather than from getting a pleasure from fellatio or cunnilingus itself. At this point, our results were different from results of Bay-Cheng, Robinson, and Zucker (2009) study, in which experiences of cunnilingus in young females were associated with positive emotional reactions.
For many of our female respondents, gaining the confidence in themselves as related to their sexual behaviour appeared to be a turning point in their oral sex experiences. This confidence provided them with a power to navigate in the complex gender-structured waters of oral sex behaviour in a search for the means to exploit its structural vulnerabilities in the way that they can change the structure for themselves. Until this change occurred, gender beliefs and power arrangements in society were still perceived by them as a threat for their sexuality and they see them as a source of their vulnerability. Once this change has happened and secured, this very personal process of overcoming power pressures and such reducing their vulnerabilities in oral sex, constantly going on the background, made females feel more psychologically comfortable, confident and successful. Problems related to their body image satisfaction seemed to become not so salient to them anymore; they faded away as their confidence and self-acceptance were growing.

Limitations
The major limitation of this study was in excluding from analysis young males. Although being previously justified as purposeful approach in this study, the future research would greatly benefit from inclusion of male students in this type of research.
Secondly, we used a relatively small convenience sample of female university students. Similar to other focus group studies investigating sexual behaviour and assessment of sexual risks in young females (e.g. Bay-Cheng et al., 2009;Zeller, 1993), our sample was comprised of a group of 24 female students who expressed the interest in the topic of oral sex and who were confident enough to participate in focus groups on such a sensitive subject. Our justification of using such narrow sample was in that the nature of qualitative research allows the narrow focus on investigating life-lived experiences of individual or small groups of individuals representing the certain homogeneous population.
Next limitation of this study was that our focus groups included female students from multicultural background. As such, our results have to be applied with caution to the population of typical British young females; nevertheless, they can be reflecting the contingent of modern university students' female population in the country. Our focus groups were also mixed in terms of students' extent of oral sex experience, and this may have inhibited some females from fully expressing their views. In addition, in this study we did not differentiate female students' oral sex experiences on the basis on their age. Further research need to explore females' oral sex experiences in different age groups and perhaps in longitudinal studies to see how this perceived vulnerability can change over time.
The use of incentives can be also seen as a potential limitation on this study. Although the use of incentives to get participants in the research may hold implications for the quality of data obtained and can compromise the voluntariness of their informed consent (e.g. Head, 2009), in the current study offering money to female students was rather an indication of respect for their time and contribution that they made. The interest in the topic and the willingness to participate in this research on oral sex was surprisingly high.
It is also important to consider that this study was explicitly focused on heterosexual females. In this sense, the large area of oral sex in bisexual or homosexual relationship was not covered at all. In the same-gender or bisexual relationships, the perception and meanings of oral sex, as well as gender power pressure and sexual self-efficacy may vary and differ from our findings, thus, this will be a very interesting and potential avenue for future research.

Implications and conclusions
In the present study, we uncovered the story of young females' physical and emotional vulnerability as related to their oral sex experiences. This vulnerability, attributed to females' perception of gender power imbalance in oral sex, was found to be fuelled by power arrangements in modern society and females's confidence to challenge these gender beliefs and societal pressures.
Findings from this study demonstrated how pushing contemporary gender theory into the area of young people sexual behaviour can provide a key for uncovering gender inequality in young females' perception of their oral sex experiences and in explaining their vulnerability within this sexual behaviour.