Increasing diversity of sexual experience – major UK study

There has been significant change in British people’s sexual behaviour and attitudes in recent decades, according one of the largest studies ever conducted on the topic. The gender gap between women and men’s sexual behaviour is narrowing, many people have expanded their sexual repertoire, and there is good evidence of continuing sexual activity as people get older.

The study also shows that levels of HIV risk behaviours reported by heterosexual people have not increased over the past decade. In addition, one-in-forty men and one-in-thirty women report having a partner of the same sex in the previous five years.

The data come from the National Survey of Sexual Attitudes and Lifestyles (Natsal), published in The Lancet this week. As this study recruited a large, representative sample from households throughout Great Britain, it is more likely than most other studies to give an accurate picture of sexual experience and behaviour across the population. An individual who has very little sex is as likely to be recruited as a person with multiple partners.

The study

In 2010 to 2012, researchers from the National Survey of Sexual Attitudes and Lifestyles (Natsal) recruited 15,162 men and women, aged 16 to 74 years, from across England, Scotland and Wales. (A fuller description of the survey’s methods is contained in another aidsmap.com article reporting its results on HIV testing.)

Although the survey is cross-sectional (it doesn’t follow individuals over time), it has now been conducted on three occasions – in 1990, 2000 and 2010. A total of 45,199 people have taken part in the three studies, providing a unique insight into changing sexual behaviour over more than two decades.

Data from previous studies have shaped sexual health policy.

While many of the same questions have been repeated in each survey, new topics have been added as the focus of the research has changed. Whereas the impetus of the 1990 study was the emerging HIV epidemic, the 2000 version was also driven by concerns about chlamydia infections and pregnancy in teenagers. The research in 2010 was informed by a holistic view of sexual wellbeing, rather than a focus on disease. Questions were asked about pleasure and sexual function, as well as sex being consensual.

Data from the previous studies have shaped sexual health policy – including how sexual health services are organised; the targeting of the teenage pregnancy strategy to low-income areas; the age at which HPV vaccination is offered; and the lowering of the age of consent for gay men.

Women's changing sexuality

The biggest changes identified by the survey concern the sexual behaviour of women, especially younger women. When the first survey took place in 1990, men had had more sexual partners than women and, while that remains the case, the gap is narrowing. Men used to have their first heterosexual experience before women, but now the average is the same for men and women (17 years).

In general, the behaviour of younger women is becoming comparable to that of younger men.The researchers suggest that these trends are best understood in the context of profound changes in the position of women in society, lifestyle norms, and media representations of female sexuality.

Sex has become increasingly detached from reproduction.

The latest results give a sense of how sex has become increasingly detached from reproduction – more women and men are reporting oral sex, anal sex, same-sex behaviour, sex at an older age, and other behaviours that have nothing to do with having children.

Anal sex is increasingly reported by heterosexual women and men. The researchers analysed generational changes, looking at individuals born between the 1940s and the 1970s who were all aged 35 to 44 when they took part in one of the surveys.

In the oldest generation (individuals born between 1946 and 1955), fewer than 20% said they had ever had anal sex. In those born a decade later, around 30% reported it, whereas for those born between 1966 and 1975, almost 40% had had anal sex.

It’s quite possible that this represents experimentation or an addition to the sexual repertoire, rather than something practised regularly.

Same-sex behaviour and social attitudes

An increasing number of women are reporting sexual experiences with other women – among those aged 25 to 34, 18% had ever had sexual contact (including kissing) with a woman, 9% had had genital contact, and 5% had a female sexual partner in the previous five years. However only 3.2% of this age group described themselves as lesbian, gay or bisexual.

Younger women and women with more education were much more likely to report same-sex experiences than other women. The number doing so increased between 2000 and 2010.

But for men, the numbers reporting same-sex experiences did not increase during the same time period, and did not vary much by age.

Of all men in the survey, 8% had ever had sexual contact (including kissing) with a man, 5.5% had had genital contact, and 2.6% had a male sexual partner in the previous five years. Moreover 2.5% described themselves as gay or bisexual.

Attitudes to adultery have become less permissive.

Comparing the surveys over the past two decades, there have been dramatic changes in people’s attitudes to homosexuality, especially in those with more education. The proportion of men saying that male same-sex partnerships are "not wrong at all" increased from 22% in 1990 to 48% in 2010. Women were consistently more tolerant – those giving the same answer rose from 28 to 66% in 2010. Attitudes to female same-sex behaviour were similar.

But at the same time, attitudes to adultery and non-exclusive marriages have become less permissive – more men (63%) and women (70%) say they are "always wrong" than in previous surveys, with the least permissive attitudes found in younger age groups. The number of men disapproving of one-night stands has also increased, suggesting to the researchers a growing intolerance of "disrespectful" sexual relationships.

Sex in later life

Health promotion is needed throughout the life course.

As people are living longer, often in relatively good health, many people continue to have sex. Among men aged 65 to 74 years, 37% had had vaginal sex in the past month and 5% had met a new sexual partner in the past year. For women in the same group, the equivalent figures were 21 and 2% respectively. The authors say that health promotion and sexual health services need to be available for people throughout the life course.

And while sexual satisfaction and the frequency with which people have sex did decline with age, this was most marked in individuals who had poor health or a long-term medical condition. Some people who were dissatisfied with their sex lives sought clinical help, most commonly from a general practitioner. The researchers say that addressing sexual problems needs to be an integral part of the management of chronic health conditions, with many clinicians and GPs needing to improve their awareness and skills in this area.

HIV risks

In terms of a number of behaviours that could be linked to risks of HIV infection, a significant increase was seen from 1990 to 2000 – the authors suggest that the first survey was conducted at the height of public concern about HIV, but that respondents were less fearful and anxious by the time of the study in 2000.

Comparing the results from 2000 and 2010, the numbers reporting risk behaviours generally either stayed stable, or decreased. However, it is worth noting that all of these data relate to the general population (aged 16 to 44 in these analyses), and some of it to specifically heterosexual acts. Analyses of behaviour change in gay men and other sub-groups have not yet been conducted.

Risk behaviours either stayed stable, or decreased.

Fewer men now report having at least two sexual partners in the previous year with whom condoms were not used – a statistically significant drop from 13.5% in 2000 to 10.7% in 2010. For women, there was no significant change in the numbers reporting this – 7.5% and 8.1% respectively.

Various indicators of partner numbers show that, in 2010, men had no more, or fewer, female partners than in 2000. For women, there was an increase in the number of male partners they had ever had, but not in numbers of sexual partners in the previous year. As widely reported in the press, the number of men and women reporting vaginal sex in the past month dropped between 2000 and 2010.

And as previously noted, the number of men having sex with other men did not change between 2000 and 2010. The number of men who had paid for sex (4% in the past five years) also stayed the same.

Sexual difficulties, sex education and rape

The researchers asked about the quality of the relationships people had with their sexual partners, their satisfaction with sex and any difficulties they had with sex. Problems in this area were commonly reported, including in younger age groups. People who had had sexual difficulties were more likely to be unhappy in their relationship, and were also more likely to have experienced non-consensual sex or have had an STI. Because of these links, the researchers suggest that sexual health services need to be more holistic – staff at sexual health clinics need to be ready to support people with sexual difficulties. Moreover, sex education in schools needs to address pleasure and relationships, not just pregnancy and infections.

Sexual health services need to be more holistic.

In terms of sex education in schools, the data on unplanned pregnancy show its long-term value. Adult women who said that school had been their main source of sex education were less likely than other women to have recently had an unplanned pregnancy.

Finally, non-consensual sex, sexual violence and rape had been experienced by far more women (9.8%) than men (1.4%) in their lifetimes. However, among men who had ever had sex with another man, rates were as high as for women (10.1%). Most often, the perpetrator was a partner, family member or friend. The victim was usually in his or her teens or twenties at the time and didn’t talk to anyone about what happened – including the police.