Sex tech has come a long way in the past 10 years—not only in terms of cultural acceptance and awareness but also technology. Gone are the days of clunky, pink, plastic rabbit vibrators and sex toys that feel like knockoff action figures. Today’s toys are designed by sex educators, medical professionals, and some of the world’s greatest sexperts. They feature ultra-premium, medical-grade silicone, robust Bluetooth connectivity, programmable vibration patterns, and multiple motors all designed to help you have a good time.
There’s never a bad time to invest in a little extra self-care. These are the best sex toys, vibrators, smart vibrators, personal wand massagers, and accessories, all of which we’ve personally tested. There’s something here for everyone, every gender, and every body. The language on these products isn’t always gender-inclusive, but we approached testing with a gender-inclusive mindset, testing these with a variety of different genitals, bodies, and partners.
Updated May 2024: We’ve added the Coconu Wave and Le Wand vibrators.
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Photograph: MyroslavaPavlyk/Getty Images
Which Toys Are for My Body?
The sex tech industry has conditioned us to think of toys in terms of male and female, penis and vagina, but that’s reductive and inaccurate, and it contributes to a larger narrative about the relationship between genitals and gender. It’s unhelpful, and I have a lot of feelings about it. We opt to be as specific as possible and use anatomical terms to describe individual erogenous zones—and there are way more than just P and V.
The vulva is the exterior part of the vagina. It includes the labia majora, labia minora, the urethra, and the clitoris. The clitoris is the center of erogenous nerves in the vulva, and it’s much larger than just the exterior portion. Its internal structures extend down to either side of the vagina, which is where you’ll find the G-spot—the area stimulated by toys that curve toward the front of your body.
The phallus is what’s commonly referred to as the shaft of the penis, and it includes a couple of erogenous zones. The glans is the top of the phallus, usually referred to as the “head,” and the frenulum is a thin strip of connective tissue on the underside of the glans that can be particularly sensitive to targeted stimulation. Last but not least, the anus is, well … it’s the butthole. The rectum is the interior portion that attaches to the anus. Both of these areas can be sensitive to internal and external stimulation.
For people born with phalluses, there’s an additional erogenous zone here: the prostate or P-spot. This is a walnut-sized gland that lives between the internal structures of the penis and the rectum, and it can be reached by toys that curve toward the front of your body.
In 2023, students protested against a new policy in Texas, where parents would be notified if their child asks to be identified as transgender.Credit: Brett Coomer/Houston Chronicle/Getty
This week, Nature is launching a collection of opinion articles on sex and gender in research. Further articles will be published in the coming months. The series will highlight the necessity and challenges of studying a topic that is both hugely under-researched and, increasingly, the focus of arguments worldwide — many of which are neither healthy nor constructive.
Some scientists have been warned off studying sex differences by colleagues. Others, who are already working on sex or gender-related topics, are hesitant to publish their views. Such a climate of fear and reticence serves no one. To find a way forward we need more knowledge, not less.
We need more-nuanced approaches to exploring sex and gender in research
Nearly 20 researchers from diverse fields, including neuroscience, psychology, immunology and cancer, have contributed to the series, which provides a snapshot of where scholars studying sex and gender are aligned — and where they are not. In time, we hope this collection will help to shape research, and provide a reference point for moderating often-intemperate debates.
For as long as scientific inquiry has existed, people have mainly studied men or male animals. Even as recently as 2009, only 26% of studies using animals included both female and male individuals, according to a review of 10 fields in the biological sciences1. This bias has had serious consequences. Between 1997 and 2000, for instance, eight prescription drugs were removed from the US market, because clinical testing had not revealed women’s greater risk of developing health problems after taking the drugs.
The tide, however, is turning. Many journals, including those in the Nature Portfolio, and funders, such as the US National Institutes of Health, have developed guidelines and mandates to encourage scientists to consider sex and, where appropriate, gender in their work.
Male–female comparisons are powerful in biomedical research — don’t abandon them
These efforts are reaping benefits2. Studies, for example, are showing that a person’s sex and/or gender can influence their risk of disease and chances of survival when it comes to many common causes of death — including cardiovascular conditions and cancer.
Despite this, many researchers remain unconvinced that the inclusion of sex and gender information is important in their field. Others, who are already doing so, have told Nature that they’re afraid of how their work is perceived and of how it could be misunderstood, or misused.
Because researchers who are exploring the effects of sex and gender come from many disciplines, there will be disagreements. An often-raised and valid concern, for example, is that when researchers compare responses between female and male animals, or between men and women, they exclude those whose sex and/or gender doesn’t fall into a binary categorization scheme. Another is that variability between individuals of the same sex could be more important than that between sexes.
Sometimes sense does seem to get lost in the debates. That the term sex refers to a lot of interacting factors, which are not fully understood, does not invalidate its usefulness as a concept3. That some people misinterpret and misuse findings concerning differences between sexes, particularly in relation to the human brain, should not mean denying that any differences exist.
Tempering the debate
Many of the questions being raised, however, are important to ask, especially given concerns about how best to investigate biological differences between groups of humans, and the continued — and, in some regions, worsening — marginalization of people whose sex and/or gender identity doesn’t fall into narrowly defined norms. Often, such questions and concerns can be addressed through research. For example, studies might find that variability between individuals of the same sex in diet, or body weight, say, are more important predictors of how likely they are to develop anaemia than whether they are male or female.
The fraught quest to account for sex in biology research
The problem, then is not the discussions alone: science exists to examine and interrogate disagreements. Rather, the problem is that debates — and work on sex and gender, in general — are being used to polarize opinions about gender identity. As Arthur Arnold, a biologist at the University of California, Los Angeles, and his colleagues describe in their Comment article, last September, legislation banning gender-affirming medical care for people under 18 years old was introduced in Texas on the basis of claims that everyone belongs to one of two gender groups, and that this reality is settled by science. It isn’t. Scientists are reluctant to study sex and gender, not just because of concerns about the complexity and costs of the research, but also because of current tensions.
But it is crucial that scholars do not refrain from considering the effects of sex and gender if such analyses are relevant to their field. Improved knowledge will help to resolve concerns and allow a scholarly consensus to be reached, where possible. Where disagreements persist, our hope is that Nature’s collection of opinion articles will equip researchers with the tools needed to help them persuade others that going back to assuming that male individuals represent everyone is no longer an option.
Over the past decade, intense and polarizing debates about transgender rights and women’s bodies have escalated worldwide — from politicians being grilled on the definition of a woman to scientific journals being critiqued for the language they use in discussions of women’s health. Meanwhile, studies have accumulated showing that the impacts of sex and gender on human health and behaviour are both far-reaching and complex. This is in part the result of major funding agencies, such as the Canadian Institutes of Health Research and the US National Institutes of Health, as well as various scientific journals1, developing guidelines and mandates to encourage scientists to consider sex and gender in their research (see Nature605, 396 (2022); Nature Commun. 13, 2845; 2022).
Given the heightened sociopolitical tensions and a widespread perception that considering sex and gender (terms we define below) will ramp up the complexity and costs of research, many scientists might feel it is prudent to avoid examining them in their work. However, studies that engage critically with sex and gender are urgently needed, both to increase understanding of humans across diverse contexts, and to provide insights for societal discussions — whether on health and disease, education or other topics.
Why it’s essential to study sex and gender, even as tensions rise
Clinicians and regulatory agencies still lack knowledge about how factors related to sex and gender, and their interactions, affect the likelihood of being prescribed a drug, of experiencing severe side effects or of receiving an incorrect dose2. Similarly, in relation to disaster relief, organizations providing aid to those in need could increase the effectiveness of their efforts if they better understood how sex and gender affect people’s ability to access health services, food or water — in the context of sexualized or gender-based violence, say, or because of gendered stereotypes and roles3. To make future products more useful to everyone, many engineering and design fields, from artificial intelligence to robotics, need sex- and gender-informed research. The design of commonly used products, such as seat belts and airbags, needs to take into account factors related to sex and gender to address women’s increased risk of injury and fatality in vehicle crashes4. We urge scientists to engage with the concepts and issues surrounding sex and gender, and to consider the relevance of them to their own field. We also entreat them to embrace complexity, and develop deeper, more-nuanced approaches to interrogating sex and gender than are most commonly used today. This means, among other things, engaging deeply with the mechanisms and factors that underlie apparent differences between groups5.
Causes of confusion
For most research that considers sex and/or gender, limited information is collected for either attribute. For studies involving humans, participants are typically asked to identify their sex and/or gender category; for those involving non-human animals, individuals are usually assigned to a sex category depending on the appearance of their genital anatomy.
Meanwhile, when it comes to promoting understanding of the concepts of sex and gender and the distinctions between them, a starting point frequently offered — including by major research funders — is that sex is biological and gender is social. In other words, sex is meant to refer to various anatomical and other biological features, whereas gender is associated with social and cultural attributes, opportunities and roles.
Splitting data by sex or gender category can be a useful starting point to help identify sex- and gender-related differences and disparities. Similarly, the ‘sex is biological and gender is social’ framing can offer a valuable initial toehold, because it serves as a reminder that not every difference observed between sex or gender groups is rooted in biology: social and environmental factors are often important, too.
Male–female comparisons are powerful in biomedical research — don’t abandon them
Ultimately, however, both the approaches commonly used to categorize individuals and the way in which many researchers think about sex and gender do not necessarily lead to studies that can adequately address the complexities and diversity of humans. They can even be misleading.
For a start, sex is not a fixed thing. Neither is gender.
For us, the term sex is best understood as both a categorization scheme (in which individuals are typically classed as male, female or intersex) and a complex constellation of traits and factors across several levels of biological organization that show considerable variability between and within individuals. Sex-related factors and traits include anatomical features, hormones, levels of gene expression and physiological, reproductive, metabolic or neurological processes — but no single trait comprehensively defines an individual’s sex. In all animals, including humans, developmental processes that occur during sexual differentiation (during fetal development and after birth) are not determined by single genes. Instead, sex phenotypes emerge from the complex interplay of numerous molecular pathways that can be influenced by environmental experiences through epigenetic, endocrine, neurological and other mechanisms across people’s lifespan6.
Similarly, the term gender encompasses much more than people’s sense of self as a gendered individual, or their ‘gender identity’. Gender can be understood as a categorization scheme, in which a person can identify as a man or woman (whether cisgender or trans), as non-binary or with one or more other evolving terms. Gender also encompasses roles, norms, relations and opportunities that vary between cultures and over time, and which affect people’s income, autonomy, domestic and public roles, and their access to power and resources.
Furthermore, sex and gender are not neatly separable.
Nature journals raise the bar on sex and gender reporting in research
Various studies have shown that environmental and social factors can affect people’s biology in numerous ways. Gendered dressing patterns affect people’s exposure to sunlight7, for instance, affecting their levels of vitamin D, which can in turn influence bone density8,9. In other words, although bone density is affected by levels of oestrogen or testosterone, it should not be understood as solely a sex-related trait, but as something that is shaped by social and environmental factors rooted in gender, too. Similarly, patterns of gendered socialization related to dress, types of play (for example, indoor or outdoor) and vigilance about cleanliness might result in boys and girls having distinct patterns of exposure to microorganisms — which could, in turn, have implications for the maturation of their immune system and susceptibility to developing conditions such as an allergy or autoimmune disorder10. Some scholars focusing on issues around sex and gender use the hybrid terms gender/sex or sex/gender in recognition of such entanglement11,12.
To add to the difficulties, many scientific organizations, journals and researchers fail to clarify what exactly they mean by sex and gender, or they conflate the terms or use them interchangeably. Moreover, patterns of use can differ according to people’s language, discipline or country. For example, the term gender medicine has been used to describe at least three distinct things: a branch of medicine focused on disease-related differences between men and women13; the study of how sex and gender influence an individual’s health14,15; and the provision of care for children with differences in sexual development16. To help address this confusion, we have mapped the relationships between various areas of science concerned with sex and gender, and policies linked to equity, diversity and inclusion17.
Embracing complexity
In our view, continued dialogue between scholars and journal editors will help to clarify and refine terminologies. However, putting aside the problems with how the terms are used and understood, when sex and gender are considered in research at all, the standard approach is to compare female and male individuals. Such comparisons can be useful for flagging characteristics that warrant further investigation. However, in making such comparisons, researchers often overlook the fact that there is substantial heterogeneity in sex/gender categories and substantial overlap between them for many traits. Ultimately, relying too heavily on a binary comparison approach risks describing the realities incorrectly for everyone, not just for women or non-binary people. It also contributes to the marginalization of those with variations in sexual development and people with diverse gender identities.
Take, for example, research on blood donation. In 2017, researchers in Canada published findings that among frequent blood donors, women had low levels of ferritin (a marker of iron levels) more often than did men18. The study prompted Canadian Blood Services — the organization that manages most of the country’s blood supply — to alter its policy on donation intervals: for all female donors, it has extended the time between donations from 8 to 12 weeks. (Since January 2023, Canadian Blood Services has also been intermittently testing ferritin levels in donors’ blood, but only in women.)
Gendered roles and behaviours affect people’s health and well-being.Credit: Diptendu Dutta/AFP/Getty
By focusing the policy on the sex category of the donor, the organization effectively treats all women as being at the same risk of low iron levels, which is higher than that of men, without attending to the specific factors that are most likely to be mechanistically related to that risk: body size, amount of menstrual blood loss and dietary iron intake. The change to donation interval for women — based on a binary analysis — also glosses over the heterogeneous and overlapping nature of the data, including the fact that the frequent donors also included women who did not have low iron levels, and men who did. A more nuanced interpretation of the findings, along with further research that probed the specific sex- and gender-related factors that increase people’s risk of developing low iron levels, could allow policies to be refined in ways that are better oriented to the mechanistic factors that matter most.
A spokesperson for Canadian Blood Services said that it recognizes that blood donors are a heterogeneous population and that it uses standardized, simple criteria to divide donors into accepted and deferred groups.
Accounting for sex and gender makes for better science
In practice, each investigator is best placed to work out which sex- and gender-related factors will be most important to assess on the basis of their study system, goals, tools, methods and resources19, and — crucially — best placed to justify these decisions. Not every possible variable relating to sex and gender needs to be interrogated in all contexts, and there is no one-size-fits-all approach.
Someone studying a new T-cell therapy for colon cancer, for example, might propose that gonadal hormones could modify the efficacy of the treatment, because T cells possess receptors for both oestrogens and androgens. If that researcher was conducting a study in people with colon cancer, they could evaluate whether correlations exist between the efficacy of the drug and serum concentrations of the relevant hormones (which can be affected by biological, social and environmental factors). If they were working with a mouse model of colon cancer, they might use antagonists or agonists of the relevant hormone receptors or give the animals hormone supplements. A different approach would be needed if the researcher was interested in whether the sex of the T-cell donor changes the efficacy of the treatment depending on the sex of the recipient.
These kinds of analysis could have resource implications: in some cases, different reagents, extra measurements or more animals or participants would be required. In our view, considerable resources should be invested in addressing long-standing gender inequities. Furthermore, researchers do not necessarily need to consider sex and gender in every experiment or study. More important is that they build sufficient skills and understanding to be able to consider the potential impacts of sex and gender and justify their research designs accordingly.
Implicit bias
In addition to considering sex and gender in their work and taking more-nuanced approaches to studying both, it is crucial that researchers explore how the influences of sex and/or gender shape their own research.
The fraught quest to account for sex in biology research
Many phenomena in diverse fields, including medicine, archaeology and history, show that science has never been insulated from social and cultural biases, or from stereotypes and mythologies about sex and gender. Funders and regulators are still trying to remedy the lack of inclusion or under-representation of women in clinical trials of drugs or devices. Such biases lead to common mislabelling such as ‘the male hormone testosterone’ or ‘the female X chromosome’ even though testosterone and X chromosomes are important for normal physiological function in all human bodies. Likewise, many studies assess the effects of androgens in only male participants, for instance, or analyse only women’s child-care responsibilities.
Truly understanding the impacts of sex and gender on human life will require a mix of transdisciplinary, quantitative, qualitative and intersectional analyses — which strive to assess how people’s experiences are shaped by interacting social processes, such as racism, sexism, homophobia, transphobia, ableism and colonialism.
Given the enormous untapped opportunities for developing insights concerning sex and gender across many contexts, it is essential that more scientists lean in with courage and creativity to interrogate the fascinating complexity of sex- and gender-related impacts — to the benefit of all.
Monkeypox virus particles (artificially coloured).Credit: UK Health Security Agency/Science Photo Library
A virulent strain of the monkeypox virus has gained the ability to spread through sexual contact, new data suggest. This has alarmed researchers, who fear a reprise of the worldwide mpox outbreak in 2022.
Evidence from past outbreaks indicates that this strain, called clade I, is more lethal than the one that sparked the 2022 global outbreak. Clade I has for decades caused small outbreaks, often limited to a few households or communities, in Central Africa. Sexually-acquired clade I infections had not been reported before 2023.
But since then, a clade I strain with an apparent capacity for sexual transmission has caused a cluster of infections in a conflict-ridden region of the Democratic Republic of the Congo (DRC), in Central Africa. A preprint1 posted on 15 April reports that 241 suspected and 108 confirmed infections are connected to this outbreak — and these numbers are probably a vast undercount because of limited testing capacity. Almost 30% of the confirmed infections were in sex workers.
Adding to the challenges, the region is facing a humanitarian crisis, and the DRC is contending with the aggressive spread of other diseases, such as cholera. The combination means there is a “substantial risk of outbreak escalation beyond the current area”, says Anne Rimoin, an epidemiologist at the University of California, Los Angeles, who has worked on mpox outbreaks in the DRC since 2002.
Unheeded warnings
Monkeypox virus can cause painful, fluid-filled lesions on the skin and, in severe cases, death. (While the disease was renamed ‘mpox’ in 2022, the virus continues to be called ‘monkeypox virus.’) The virus persists in wild animals in several African countries, including the DRC, and occasionally spills into people.
The first large reported outbreak with human-to-human transmission , which was in 2017 in Nigeria, caused more than 200 confirmed and 500 suspected cases of the disease. Researchers warned at the time that the virus might have adapted to spread through sexual contact.
Their warnings were not heeded; in 2022, a global outbreak driven in part by sexual contact prompted the World Health Organization (WHO) to declare it a public health emergency. That ongoing outbreak is caused by a strain of monkeypox virus called clade II, which is less lethal than clade I, and has infected more than 94,000 people and killed more than 180.
Monkeypox in Africa: the science the world ignored
Although mpox infections have waned globally since 2022, they have been trending upwards in the DRC: in 2023 alone, the country reported more than 14,600 suspected infections and more than 650 deaths. In September, 2023, a new cluster of suspected cases arose in the DRC’s South Kivu province. This cluster especially concerns researchers, as it has been spreading largely among sex workers, suggesting that the virus has adapted to transmit readily through sexual contact.
This could lead to faster human-to-human spread, potentially with few symptoms, says Nicaise Ndembi, a virologist at the Africa Centres for Disease Control and Prevention who is based in Addis Ababa. “The DRC is surrounded by nine other countries — we’re playing with fire here,” he says.
Health officials are so concerned that representatives of the DRC and 11 nearby countries met earlier this month to plan a response and to commit to stepping up surveillance for the virus. Only about 10% of the DRC’s suspected mpox cases in 2023 were tested, due to limited testing capacity, meaning health officials “don’t have a full picture of what’s going on”, Ndembi says.
Genetic analyses of the virus responsible for the outbreak show mutations such as the absence of a large chunk of the virus’s genome, which researchers have previously noted as a sign of monkeypox viral adaptation. This has led the study’s authors to give a new name to the strain circulating in the province: clade Ib.
Making matters more fraught, South Kivu borders Rwanda and Burundi and is grappling with “conflict, displacement, food insecurity, and challenges in providing adequate humanitarian assistance”, which “might represent fertile ground for further spread of mpox”, the WHO warned last year.
Vaccines and treatment needed
In 2022, many wealthy countries offered vaccines against smallpox, which also protect against mpox, to individuals at high risk of contracting the disease. But few vaccine doses have reached African countries, where the disease’s toll has historically been highest.
While the DRC weighs regulatory approval for these vaccines, the United States has committed to providing the DRC with enough doses to inoculate 25,000 people, and Japan has said it will also provide vaccines, says Rosamund Lewis, technical lead for mpox at the WHO in Geneva, Switzerland. But a vaccination drive in the DRC would require hundreds of thousands — if not millions — of doses to inoculate individuals at high risk of infection, she says.
It’s not clear how much protection these vaccines will provide against clade I mpox, but Andrea McCollum, a poxvirus epidemiologist at the US Centers for Disease Control and Prevention in Atlanta, Georgia, says that data from tests in animals are promising. Researchers are also conducting a trial in the DRC of tecovirimat, an antiviral that is thought to be effective against mpox. Results are expected in the next year, McCollum says.
The WHO and CDC have helped to procure equipment that will allow for more rapid diagnosis of the disease in the DRC, especially in rural areas, Lewis says. She adds that says the rapid mobilization of African health officials gives her hope that the outbreak can be controlled before clade Ib mpox starts spreading elsewhere.
