If Cincinnati ranks #4 in sexual satisfaction, it's probably because that puritanical town forbids itself to think any "dirty thoughts."
Case in point: A few years ago, the Cincinnati-based Citizens for Community Values successfully lobbied the Ohio State Legislature to ban physical contact between dancers and patrons in strip clubs:
http://www.ccv.org/issues/sex-orient...y-defense-act/
Remarking that he had more important issues, such as unemployment, to address, the governor let the bill become law, rather than veto it.