Studies regarding the meaning of sexual intercourse sometimes conflict. While most consider penile–vaginal intercourse to be sex, whether anal or oral intercourse are considered sex is more debatable, with oral sex ranking lowest. The Centers for Disease Control and Prevention (CDC) stated that "although there are only limited national data about how often adolescents engage in oral sex, some data suggest that many adolescents who engage in oral sex do not consider it to be 'sex'; therefore they may use oral sex as an option to experience sex while still, in their minds, remaining abstinent". Upton et al. stated, "It is possible that individuals who engage in oral sex, but do not consider it as 'sex', may not associate the acts with the potential health risks they can bring." In other cases, condom use is a factor, with some men stating that sexual activity involving the protection of a condom is not "real sex" or "the real thing". This view is common among men in Africa, where sexual activity involving the protection of a condom is often associated with emasculation because condoms prevent direct penile–to–skin genital contact.