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Masturbation, paying for sex, and other sexual activities:
the Second Australian Study of Health and Relationships
Juliet Richters
A,I
, Richard O. de Visser
B
, Paul B. Badcock
C,D
, Anthony M. A. Smith
C,H
,
Chris Rissel
E
, Judy M. Simpson
F
and Andrew E. Grulich
G
A
School of Public Health and Community Medicine, University of New South Wales,
Sydney, NSW 2052, Australia.
B
School of Psychology, Pevensey 1, University of Sussex, Falmer BN1 9QH, UK.
C
Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street,
Melbourne, Vic. 3000, Australia.
D
Centre for Youth Mental Health, University of Melbourne, Orygen Youth Health Research Centre,
35 Poplar Road, Parkville, Vic. 3052, Australia.
E
Sydney School of Public Health, Charles Perkins Centre (D17), University of Sydney, Sydney,
NSW 2006, Australia.
F
Sydney School of Public Health, Edward Ford Building (A27), University of Sydney, Sydney,
NSW 2006, Australia.
G
The Kirby Institute, Wallace Wurth Building, University of New South Wales, Sydney,
NSW 2052, Australia.
H
Deceased.
I
Corresponding author. Email: j.richters@unsw.edu.au
Abstract. Background:This study describes the prevalence of (solo) masturbation, paying for sex and a range of other
sexual practices among Australians. Methods:A representative sample of 20 094 men and women aged 16–69 years
(participation rate among eligible people, 66.2%) were recruited by landline and mobile phone random-digit dialling and
computer-assisted telephone interviews in 2012–13. Results:Many respondents (men, 72%; women, 42%) had
masturbated in the past year. Half (51%) of the men and 24% of women had masturbated in the past 4 weeks. In the
past year, more than two-fifths of respondents (men, 63%; women, 20%) had looked at pornography in any medium.
Approximately 15% of men and 21% of women had used a sex toy. Digital-anal stimulation with a partner was practised by
19% of men and 15% of women, and oral-anal stimulation by 7% of men and 4% of women. Sexual role playing or dressing
up were engaged in by 7–8%. Online sex, swinging, group sex, BDSM (bondage and discipline, ‘sadomasochism’or
dominance and submission) and fisting (rectal or vaginal) were each engaged in by less than 3% of the sample. Seventeen
per cent of men said they had ever paid for sex; 2% had done so in the past year. Conclusion:Most of the solo practices
studied were engaged in by more men than women, but women were more likely to have used a sex toy. Autoerotic
activities are both substitutes for partnered sex and additional sources of pleasure for people with sexual partners.
Additional keywords: anilingus, brachioproctic eroticism, dildo, erotica, fetishism (psychiatric), Internet, rimming, sexual
behaviour, vibrator.
Received 18 June 2014, accepted 23 August 2014, published online 7 November 2014
Introduction
Masturbation and other non-intercourse sexual activities are
important in sexual health research despite their low or non-
existent risk of infection. At a practical public health level, the
acceptability of non-coital practices influences the potential for
health promotion programs to reduce risk by encouraging people
to shift from high-risk practices (e.g. vaginal intercourse without
a condom when pregnancy is not desired) to lower-risk practices
such as oral sex or manual sex. These are discussed in other
articles in this issue.
1,2
Solo sexual activity or masturbation is
also a matter of concern in many societies. Although Western
professional opinion became united on the harmlessness of
masturbation during the 20th century,
3–5
concern about solo
sexual pursuits resurfaces in each generation and is currently
focused on Internet use and the constructs of ‘Internet addiction’
and ‘pornography addiction’.
6
For this reason, we added further
questions on Internet use and pornography consumption in the
Second Australian Study of Health and Relationships (ASHR2).
CSIRO PUBLISHING
Sexual Health, 2014, 11, 461–471
http://dx.doi.org/10.1071/SH14116
Journal compilation CSIRO 2014 www.publish.csiro.au/journals/sh
This article does not seek to evaluate the healthiness of the
practices reported.
There is surprisingly little research on masturbation
compared with the earnest focus on vaginal intercourse
(particularly age at coital debut), anal intercourse (particularly
numbers of partners and condom use) and oral sex (particularly
among the young); this focus reflects concern about disease
transmission and sex between young people. As we remarked in
2003 when reporting the first Australian Study of Health and
Relationships (ASHR1), much of the scholarly literature on
sexual practices other than those regarded as risk practices for
HIV, sexually transmissible infections (STIs) or unintended
pregnancy tends to be ‘psychological, psychoanalytical or
criminological in approach, often seeking to identify causes
or pathological correlates for uncommon sexual tastes’,
7
and this
seems still to be the case. It is also still true that psychological
studies are often based on restricted samples such as university
students, clinical patients or convicted offenders. Much of the
literature on masturbation in the medical literature is concerned
with case reports of autoerotic injuries or mishaps, infant or
child masturbation (still a matter for parental concern, it seems);
a few papers discuss masturbation as part of sexual therapy or
rehabilitation after surgery. Since our earlier report on these
topics, there is more information on masturbation from national
surveys. For example, recently in Britain, the National Survey
of Sexual Attitudes and Lifestyles (Natsal-3) found that 66%
of men and 33% of women aged 16–74 years had masturbated
in the past 4 weeks.
8
Similarly in a US probability-panel survey,
66% of men and 47% of women aged 18–69 years had
masturbated alone in the past 90 days.
9,10
Increasing diversity of sexual practices among younger
adults
1
and greater exposure to pornography via the Internet
mean that sexual satisfaction is potentially increasingly available
from multiple sources. How this impacts upon commercial sex
(men paying for sex) in the Australian context is not known. In
Britain, the Natsal-1 and Natsal-2 surveys found that 2.0% of
men aged 16–44 years in 1990 and 4.2% in 2000 had paid for
sex with a woman in the previous 5 years.
11
A review of the
proportion of men who had paid for sex in the past year placed
Australia, with a prevalence of 1.8% in 2002 (calculated from
ASHR1 data), just below the median of the range of high-income
countries with available data (range from Germany 0.0% in
1998 to Spain 11.0% in 1990).
12
No other country has reported
prevalence data on less common sexual practices such as digital-
anal stimulation or bondage and discipline and related practices,
colloquially referred to as ‘kinky’or ‘fetish’sex.
This article aims to update our description of a range of sexual
practices, including several not included in any other national
surveys, and to locate them in sociodemographic context.
Methods
The methodology used in ASHR2 is described elsewhere in this
issue.
13
Briefly, between October 2012 and November 2013,
computer-assisted telephone interviews were completed by a
representative sample of 20 094 Australian men and women
aged 16–69 years from all states and territories. Respondents
were selected using dual-frame modified random-digit dialling
(RDD), combining directory-assisted landline-based RDD
with RDD of mobile telephones. The overall response rate
(participation rate among eligible people) was 66.2%.
To maximise the number of interviews with people who
had engaged in less common and/or more risky behaviours, all
respondents who had had no sexual partners in the previous year,
who had had more than one partner in the previous year, and/or
who reported homosexual experience completed a long form
of the survey instrument, which collected detailed data on
their sexual attitudes, relationships and behaviours. Of the
larger proportion of respondents who reported one partner in
the previous year and no homosexual experience, a randomly
selected 20% completed the long-form interview and the other
80% completed a short-form interview. Answers to questions
that occurred only in the long-form interview are reported after
weighting to reflect the sample as a whole.
Questions asked about (solo) masturbation and other sexual
activities reported here are shown in Box 1(no questions were
asked about self-stimulation in front of a partner or during sex
with a partner). As some of the practices are ‘esoteric’, that is to
say, they do not belong in the standard menu of practices in a
typical heterosexual encounter, we were concerned not to risk
putting off the more conservative respondents by confronting
them with terms or concepts that they might find offensive. For
this reason, the practices were ordered carefully with the less
common and anal practices towards the end. Skip patterns in the
computer-assisted telephone interview also prevented people
being asked inappropriate questions; for example, they were not
asked about rimming unless they had reported experience
of both oral–genital sex (earlier in the interview) and digital
anal stimulation. If a respondent indicated any disapproval or
discomfort during this sequence of questions, interviewers were
instructed to ‘skip out’of the section and continue with the next
module of questions. In the analyses that follow, the skipped-out
respondents are still included in the denominator; that is, the
percentages given are lower-bound estimates based on the total
sample, not only on the valid responses from people actually
asked each question. Box 2shows the questions asked about use
of the Internet and smartphones, and Box 3details the questions
asked of men about paying for sex.
Correlates of masturbation and paying for sex examined
in this paper included a range of demographic characteristics,
recoded to facilitate analysis. Respondents’ages were recoded
into six groups (16–19, 20–29, 30–39, 40–49, 50–59 and
60–69 years). Sexual identity (in answer to the question ‘Do
you think of yourself as ...’) was coded as heterosexual,
homosexual or bisexual; too few respondents stated that they
were ‘queer’,‘other’or ‘undecided’to allow analyses of
these groups. Respondents’reports of alcohol consumption
frequency and volume were used to determine whether their
consumption exceeded Australian National Health and Medical
Research Council 2001 guidelines.
14
Respondents’reports
of their highest completed level of education were recoded to
distinguish between those who had not (yet) completed
secondary school, those who had completed secondary school
and those who had completed post-secondary education.
Respondents’postcodes were used with the Accessibility/
Remoteness Index of Australia (ARIA)
15
to determine
whether respondents lived in a major city, a regional area or
a remote area (i.e. areas with relatively unrestricted, restricted
462 Sexual Health J. Richters et al.
and very restricted access to goods, services and opportunities
for social interaction, respectively). To approximate the gross
annual household income quintiles reported by the Australian
Bureau of Statistics (2011) for 2009–10,
16
respondents’reports
of their annual household income were grouped into five
categories: less than $28 000, $28 001–$53 000, $53 001–
$83 000, $83 001–$125 000 and over $125 000. Respondents’
reports of their occupations were coded into the nine major
categories of the Australian Standard Classification of
Occupations,
17
and then recoded to distinguish between
managerial/professional occupations, white-collar occupations
and blue-collar occupations. Finally, the main outcome variables
were compared with those of ASHR1 to identify significant
changes over time.
Data were weighted to adjust for the probability of each
respondent being selected for a landline or mobile phone
interview, a long-form interview, and (for landline
participants) the number of in-scope adults in the household.
Data were then weighted to match the Australian population on
the basis of age, gender, area of residence (i.e. state by ARIA
category) and telephone ownership (i.e. mobile telephone only
vs other), resulting in an adjusted sample of 10 056 men and
10 038 women (total 20 094). The data were thus weighted
to account for the specifics of our sample design and the
fact that particular types of people were slightly over- or
under-represented. The data presented therefore describe a
representative sample of the Australian population aged
16–69 years, subject to the biases noted elsewhere.
13
Weighted data were analysed using the survey estimation
commands in Stata Version 11.2.
18
Data were analysed using
univariate logistic regression for dichotomous outcomes,
including comparisons of ASHR1 and ASHR2. Correlates of
polytomous outcomes were identified using univariate
multinomial logistic regression. Correlates of continuous
outcomes were identified using univariate linear regression.
Percentages are presented in this article without standard
Box 1. Ascertainment of participation in masturbation and other sexual practises
Note: Questions related to partnered sex were not asked of people who had had no sexual partners in the past year.
The next section is about things that some people do to add to sexual stimulation. If you have not heard of any of the things I read
out, just tell me.
Have you ever looked at pornographic material? (Interviewer note:This includes magazines,pictures,cards,films,books and
material on the Internet. Anything that the respondent considers to be porn or explicit erotic material.)
(If yes) And have you looked at it in the last 12 months?
In the last 12 months, have you ever masturbated alone? (Prompt:‘Stimulated yourself.’)
(If yes) In the last 4 weeks, how many times have you masturbated alone? (Interviewer note:Orgasm is not required for activity to
qualify as masturbation.)
In the last 12 months, have you watched an X-rated movie? (If asked:‘X is classified as movies containing only sexually explicit
content—from sex shops or mail order in New South Wales. R-rated does not count.’)
In the last 12 months, have you used a sex toy such as a vibrator or dildo? (Any other toys such as butt plugs,ben-wa balls etc. are
included. Do not include feathers,canes,massage oil,etc.)
(From here on,skip rest of section if respondent does not understand questions or expresses discomfort.)
(If yes to above question) In the last 12 months, have you used a sex toy such as a vibrator or dildo during sex with a partner?
In the last 12 months, have you been involved in role playing or dressing up? (Includes playing games like naughty schoolgirl,
captain and cabin boy etc. or dressing up in fetish gear.)
In the last 12 months have you been involved in B&D or S&M? That’s bondage and discipline, sadomasochism, or dominance and
submission.
(If had 2+partners in the past year) And in the last 12 months, have you been involved in group sex?
(If had 2+partners in the past year) And in the last 12 months, have you been involved in swinging? (Prompt:‘You and your
partner engaging in sexual activity with another couple.’)
And in the last 12 months, have you used your fingers to stimulate a partner’s anus, or had a partner do that to you? (Not asked if
respondent has no experience of manual sex. If respondent makes negative comment,skip rest of section.)
And in the last 12 months, have you been involved in fisting? (Do not explain. Includes both receptive and insertive,vaginal and
rectal fisting,if respondent asks which. Not asked if respondent has no experience of digital anal stimulation.)
Oral–anal contact or rimming, in the last 12 months? (Not asked unless respondent has experience of both oral sex and digital anal
stimulation.)
Masturbation, paying for sex, and other activities Sexual Health 463
errors or 95% confidence intervals (CI). This decision was made
to maximise both readability and brevity and is in keeping with
the style of other studies of a similar scope and intent.
19–21
Further information about the precision of estimates is found
elsewhere in this issue.
13
Due to the large number of participants
in ASHR2, the study has the statistical power to detect even
small differences between groups as statistically significant, but
these do not necessarily correspond to important differences in
practical terms.
Results
Masturbation
Men were much more likely (72%) than women (42%) to have
masturbated in the last year (P<0.001) or in the past 4 weeks
(51% vs 24%, P<0.001). Men also masturbated much more
often in the past 4 weeks (P<0.001), with a mean frequency of
3.4 times (95% CI: 3.1–3.6) compared with less than once
a month (0.8 times, 95% CI: 0.7–0.9) for women (Table 1).
Among those who had masturbated in the previous 4 weeks, men
did so a mean of 6.3 times (CI: 5.9–6.7) and women 3.1 times
(CI: 2.9–3.4).
In general, men, those with more education and higher
incomes, non-heterosexuals, those who had looked at
pornography, those with broader sexual repertoires (e.g. those
who reported digital anal stimulation or use of a sex toy) and
those with two or more sexual partners were more likely to have
masturbated in the past year (Table 2). People who did not speak
English at home and people with a religion were less likely to
have masturbated, as were people with a live-in regular partner.
Age patterns differed for men and women. Men under
30 years were most likely to masturbate, with the rate falling
in each 10-year age group thereafter. Among women, the highest
rates were for those aged between 20 and 50 years; younger and
older women were less likely to masturbate.
Other sexual activities
Table 3displays the proportions of respondents who in the
12 months before being interviewed had engaged in a range of
autoerotic and other sexual behaviours. Rates of most of these
activities were higher for men than women. For men, by far
the most common other activity was looking at pornographic
Table 1. Frequency of masturbation in the past year and the past 4 weeks
Unless indicated otherwise, data show the percentage of respondents in each category. Relative risk (RR) ratios and 95%
confidence intervals (CI) are given for women versus men, as determined by multinomial logistic regression
Men (n= 9985) Women (n= 9703) RR (95% CI)
Masturbated in the past 12 months
No 26.3 54.3 1
Yes 72.0 42.4 0.29 (0.25–0.32)
Don’t remember 0.0 0.3 –
A
Refused 1.7 3.1 0.86 (0.59–1.26)
Masturbated in the past 4 weeks
Never 44.4 74.2 1
Less than once a week 26.7 18.5 0.41 (0.36–0.48)
1–3 times a week 19.7 5.4 0.16 (0.13–0.20)
4–6 times a week 2.9 0.3 0.07 (0.04–0.12)
Daily or more often 2.1 0.2 0.05 (0.03–0.09)
Don’t remember 3.1 1.2 0.22 (0.12–0.41)
Refused 1.1 0.3 0.17 (0.08–0.37)
No. of times masturbated in the past 4 weeks
Median 1 time 0
Overall mean 3.4 times 0.8 times
Mean no. of those who masturbated 6.3 times 3.1 times
Maximum 100 times 100 times
A
Too few responses for analysis.
Box 2. Ascertainment of use of the Internet for sex
Have you ever used an Internet site or a smartphone
application to look for potential partners?
(If yes) Have you done so in the past year?
Have you had online sex with someone during the
last year?
In the last year have you met someone in person that you
met first on an Internet site?
Box 3. Ascertainment of men’s experience of paying for
sex with women
Have you ever paid anyone to have sex with you,
including oral sex and manual stimulation?
Have you paid to have sex with a woman in the last
12 months?
Questions were also asked about men paying for sex with
men, women paying for sex, and men and women being
paid for sex.
464 Sexual Health J. Richters et al.
Table 2. Correlates of masturbation in the past year
Unless indicated otherwise, data show the percentage of respondents in each category who masturbated in the past year. Unadjusted odds ratios
(OR) and 95% confidence intervals (CI) are given for masturbation, relative to reference category, separately for men and women. Note, nvaries
due to missing data for correlates
Correlates Men (n= 10 056) OR (95% CI) Women (n= 10 038) OR (95% CI)
Overall 72.0 42.4
Age (years)
16–19 84.6 0.93 (0.57–1.51) 30.8 0.48 (0.32–0.71)
20–29 85.6 1 48.3 1
30–39 78.1 0.60 (0.40–0.92) 50.5 1.09 (0.81–1.48)
40–49 75.0 0.51 (0.34–0.75) 48.5 1.00 (0.76–1.34)
50–59 64.2 0.30 (0.21–0.44) 35.2 0.58 (0.44–0.77)
60–69 46.0 0.14 (0.10–0.21) 26.5 0.39 (0.29–0.52)
Language spoken at home
English 73.2 1 43.6 1
Other 58.6 0.52 (0.36–0.74) 23.4 0.39 (0.25–0.63)
Sexual identity
Heterosexual 71.3 1 41.2 1
Homosexual 95.6 8.73 (4.41–17.29) 70.2 3.36 (2.03–5.57)
Bisexual 94.8 7.28 (2.60–20.39) 72.5 3.76 (2.19–6.44)
Education
Less than secondary 64.5 1 29.5 1
Secondary 73.8 1.55 (1.20–2.01) 40.3 1.62 (1.23–2.12)
Post-secondary 73.0 1.49 (1.16–1.92) 47.1 2.13 (1.68–2.70)
Religion
No 77.3 1 48.9 1
Yes 66.0 0.57 (0.47–0.68) 35.5 0.57 (0.48–0.68)
Region
Major city 73.3 1 43.6 1
Regional 68.3 0.79 (0.65–0.95) 39.1 0.83 (0.69–1.00)
Remote 75.0 1.09 (0.62–1.92) 57.1 1.73 (0.79–3.79)
Household income
$28 000 69.0 1 40.8 1
$28 001–$53 000 68.2 0.96 (0.69–1.35) 38.7 0.92 (0.69–1.23)
$53 001–$83 000 70.1 1.08 (0.78–1.50) 45.4 1.21 (0.91–1.60)
$83 001–$125 000 73.9 1.27 (0.92–1.76) 45.3 1.20 (0.91–1.58)
>$125 000 78.2 1.62 (1.18–2.20) 47.7 1.32 (1.01–1.74)
Occupation
Blue collar 71.4 1 40.8 1
White collar 77.4 1.37 (1.06–1.78) 41.2 1.02 (0.74–1.36)
Manager/professional 69.4 0.91 (0.73–1.12) 45.4 1.21 (0.90–1.63)
Relationship status
No regular partner 88.8 1 45.4 1
Non-live-in regular partner 85.5 0.75 (0.44–1.27) 55.8 1.52 (1.10–2.08)
Live-in regular partner 66.7 0.25 (0.17–0.38) 39.0 0.77 (0.64–0.92)
No. of sexual partners in past year
None 68.9 1 33.5 1
One 68.9 1.00 (0.84–1.20) 41.4 1.41 (1.21–1.64)
Two or more 90.7 4.39 (3.41–5.66) 74.3 5.76 (4.52–7.33)
Looked at pornography
No 44.3 1 34.1 1
Yes 88.7 9.91 (7.96–12.35) 74.9 5.75 (4.46–7.42)
Watched X-rated movie
No 66.4 1 40.2 1
Yes 85.8 3.07 (2.37–3.97) 68.4 3.22 (2.38–4.34)
Used a sex toy
A
in the past year
No 70.5 1 33.9 1
Yes 83.8 2.16 (1.58–2.95) 75.3 5.93 (4.68–7.52)
Digital anal stimulation in past year
No 69.9 1 40.3 1
Yes 86.8 2.83 (2.04–3.92) 64.8 2.74 (2.06–3.64)
A
Examples include a vibrator or dildo.
Masturbation, paying for sex, and other activities Sexual Health 465
material; nearly two-thirds of all men (63%) had done this. For
men, the next most common other activities were watching an
X-rated movie (31%) and digital anal stimulation of or by the
partner (19%). For women, the most common other activities
were using a sex toy (21%), looking at pornography (20%) and
digital anal stimulation (15%). Of those who had used a sex toy,
nearly three-quarters had used one during sex with a partner,
leaving one-quarter who had used a sex toy only when alone. For
men, the difference was smaller; few of the men had used a sex
toy alone but not with a partner (Table 3).
Paying for sex
Among men, 16.7% had ever paid for sex; only 0.3% of women
had done this (P<0.001). Very few people reported that they
had ever been paid to have sex with someone: 1.3% of men and
1.0% of women (P= 0.27). Ever having paid for sex was more
common among men with no regular partner, those who had
first vaginal intercourse before age 16 years, those who had
experience of heterosexual anal sex and those with a higher
level of alcohol consumption or experience of injecting drugs
(Table 4). In the year before being interviewed, 2.3% of men
had paid for sex. Having paid for sex in the past year was
more common among men with no regular partner, men in
remote areas, men with higher alcohol consumption or who had
ever injected drugs and those who had ever had heterosexual
anal sex.
Comparison with ASHR1
Some questions asked in ASHR1 were not repeated in ASHR2,
and some new questions were added in ASHR2. ASHR1 asked
about whether respondents had ‘gone to a sex site on the Internet
on purpose’; 16.4% of men and 2.4% of women said they had.
The proportions of ASHR2 respondents under 60 years who had
‘looked at pornography’(in any medium; 68.0% of men and
23.9% of women) are considerably higher. However, these
findings are not directly comparable, as we do not know how
many people looked at pornography in non-Internet media in
2001–02.
Comparisons for identical or almost identical questions
are shown in Table 5. Significant increases were apparent for
reporting masturbation, use of a sex toy, meeting a sexual partner
via the Internet, role playing/dressing up, and among men, anal
fingering and rimming.
Findings for lifetime experience of sex work were similar to
results
22
from the earlier ASHR1 survey: 15.6% of men in
ASHR1 and 16.0% of men under 60 years in ASHR2 had
ever paid for sex (P= 0.69). Somewhat more (but still very
few) women reported having ever been paid for sex (ASHR1,
0.5%; ASHR2, 1.0%; P= 0.002).
Discussion
Apart from masturbation and sex work, we have no
representative sample data from other countries with which to
compare Australian findings.
Solo masturbation is a common but not universal practice.
The sex differences in masturbation prevalence and frequency
are a robust finding across many studies.
8–10,19,23,24
Gender and
other sociodemographic differences in masturbation prevalence
suggest both a sexual interest or ‘randiness’element and a
sociocultural influence making masturbation more acceptable
or less taboo among better-educated and wealthier people.
Perhaps the professional view of masturbation as harmless to
health has permeated better through educated circles. From the
point of view of learning for healthy sexual development,
25
it is
Table 3. Engagement in autoerotic and less common non-coital sexual practices in the past year
Percentages are for those answering ‘Yes’as a proportion of the total, which included ‘No’, Don’t know/Can’t remember and refused.
Where a question was not asked due to a prior skip out when the respondent indicated discomfort, this is also counted in the denominator.
Unadjusted odds ratios (OR) and 95% confidence intervals (CI) are given for women versus men. BDSM, bondage and discipline,
‘sadomasochism’or dominance and submission
Non-coital sexual practice Men (n= 10 056) Women ( n= 10 031) OR (95% CI)
All respondents
Looked at pornography (%) 63.1 20.2 0.15 (0.13–0.17)
Watched an X-rated movie (%) 31.0 9.0 0.23 (0.20–0.27)
Used a sex toy
A
(%) 14.5 20.7 1.80 (1.55–2.09)
Used the Internet or a phone app to look for partners (%) 7.0 3.8 0.52 (0.42–0.65)
Had online sex (%) 0.6 0.2 0.39 (0.21–0.71)
Respondents with a sexual partner in the past year
n9880 9961
Met a new sexual partner via the Internet (%) 2.5 1.3 0.53 (0.39–0.73)
Used a sex toy
A
during sex with a partner (%) 13.8 15.9 1.18 (1.00–1.40)
Role play or dressing up (%) 7.3 8.3 1.15 (0.89–1.49)
BDSM (%) 2.5 1.6 0.63 (0.43–0.92)
Had group sex (%) 1.9 0.5 0.26 (0.17–0.40)
Swinging (%) 0.1 0.3 2.33 (1.06–5.16)
Digital anal stimulation (%) 18.6 15.2 0.78 (0.66–0.93)
Fisting (hand or fist in vagina or rectum) (%) 0.7 0.5 0.73 (0.33–1.62)
Rimming (oral anal stimulation) (%) 7.4 4.1 0.50 (0.41–0.70)
A
Examples include a vibrator or dildo.
466 Sexual Health J. Richters et al.
Table 4. Correlates of men having paid for sex ever and in the past year
Unless indicated otherwise, data show the percentage of respondents in each category who paid for sex. Unadjusted odds ratios (OR) and 95%
confidence intervals (CI) are given for paying for sex, relative to the reference category. Note, nvaries due to missing data for correlates.
NHMRC, National Health and Medical Research Council
Correlate Ever paid for sex (n= 10 056) Paid for sex in past year (n= 8581)
% OR (95% CI) % OR (95% CI)
Overall 16.7 2.3
Age (years)
16–19 2.8 0.22 (0.11–0.46) 1.3 0.45 (0.15–1.32)
20–29 11.4 1 3.0 1
30–39 16.4 1.52 (1.02–2.27) 2.7 0.91 (0.48–1.72)
40–49 22.3 2.22 (1.54–3.20) 1.9 0.62 (0.34–1.12)
50–59 19.0 1.83 (1.28–2.61) 2.4 0.80 (0.46–1.37)
60–69 20.3 1.98 (1.38–2.84) 2.1 0.70 (0.38–1.28)
Language spoken at home
English 17.0 1 2.2 1
Other 12.8 0.72 (0.47–1.11) 3.2 1.44 (0.68–3.03)
Sexual identity
Heterosexual 16.6 1 2.3 1
Homosexual 14.3 0.83 (0.53–1.32) 1.2 0.53 (0.16–1.76)
Bisexual 22.9 1.49 (0.91–2.43) 4.0 1.78 (0.62–5.10)
Education
Less than secondary 17.6 1 1.9 1
Secondary 17.4 0.98 (0.74–1.32) 2.6 1.33 (0.75–2.50)
Post-secondary 15.8 0.88 (0.66–1.17) 2.3 1.21 (0.66–2.21)
Religion
No 17.7 1 2.6 1
Yes 15.8 0.88 (0.71–1.07) 2.1 0.79 (0.54–1.16)
Religious attendance
Never or less than monthly 17.5 1 2.5 1
At least monthly 13.1 0.71 (0.52–0.98) 1.4 0.54 (0.26–1.08)
Region
Major city 15.8 1 2.3 1
Regional 18.3 1.19 (0.96–1.49) 2.0 0.88 (0.54–1.45)
Remote 19.7 1.31 (0.74–2.31) 5.8 2.63 (1.04–6.67)
Household income
Very low 13.9 1 1.6 1
Low 18.1 1.37 (0.96–1.97) 4.1 2.68 (1.33–5.41)
Middle 17.2 1.28 (0.92–1.80) 2.8 1.82 (0.93–3.55)
High 17.9 1.35 (0.96–1.91) 2.0 1.30 (0.63–2.70)
Very high 17.4 1.31 (0.94–1.82) 1.6 1.05 (0.55–2.03)
Occupation
Blue collar 20.9 1 2.9 1
White collar 16.3 0.69 (0.52–0.91) 2.1 1.72 (0.44–1.18)
Manager/professional 16.8 0.86 (0.68–1.08) 2.1 0.70 (0.45–1.08)
Relationship status
No regular partner 25.1 1 11.3 1
Non-live-in regular partner 15.4 0.54 (0.37–0.79) 3.4 0.28 (0.16–0.49)
Live-in regular partner 16.2 0.58 (0.44–0.76) 1.0 0.08 (0.05–0.13)
Ever looked at pornography
No 4.8 1 0.5 1
Yes 19.1 4.73 (3.06–7.32) 2.8 6.29 (2.42–16.37)
State/territory of residence
New South Wales 18.5 1 2.5 1
Victoria 14.1 0.72 (0.54–0.96) 2.0 0.81 (0.48–1.37)
Queensland 16.3 0.85 (0.64–1.14) 1.6 0.61 (0.33–1.13)
Western Australia 19.4 1.06 (0.76–1.48) 3.6 1.47 (0.82–2.61)
South Australia 12.0 0.60 (0.38–0.94) 2.3 0.93 (0.45–1.89)
Australian Capital Territory 19.3 1.06 (0.48–2.32) 2.2 0.87 (0.21–3.72)
Tasmania 9.5 0.46 (0.24–0.87) 1.9 0.73 (0.22–2.50)
Northern Territory 38.7 2.78 (1.27–6.07) 7.8 3.31 (0.69–15.94)
(continued next page)
Masturbation, paying for sex, and other activities Sexual Health 467
disappointing that masturbation is relatively uncommon among
younger women, as it is generally agreed to have benefits for
women in learning about their own bodies and negotiating more
rewarding sexual practice with partners.
26–29
It is curious that
women are most likely to masturbate from their 20s to their
40s, and less likely in their teens, even though they generally
reach puberty younger than boys. Evidence on the effect of
masturbation taboos is inconsistent. In a qualitative study in
Queensland, Watson and McKee
30
reported that ‘the question of
how or why a woman would masturbate was raised in the
majority of the female focus groups [about masturbation in
the media]’. Although young men joked often disparagingly
among themselves about masturbation, the topic appeared to be
unspeakable among young women, a finding echoing an earlier
UK study
31
in which young women said in interviews that
they had never spoken to anyone, even their friends, about
masturbation. This is despite calm and informative coverage of
the topic in young women’s magazines.
30
A small qualitative
study in the US uncovered similar unease among women about
masturbation, especially with sex toys, which were seen by
some as threatening to male partners.
32
In contrast, an analysis of
online sexual health forums found that women discussed
masturbation in a positive manner, while men often used
vulgar or euphemistic terms and referred to masturbation
negatively, to be resorted to in the absence of a partner or as
a cause of sexual dysfunction.
33
Table 4. (continued )
Correlate Ever paid for sex (n= 10 056) Paid for sex in past year (n= 8581)
% OR (95% CI) % OR (95% CI)
Alcohol consumption
Within 2001 NHMRC guidelines 15.7 1 2.1 1
Exceeds 2001 NHMRC guidelines 34.3 2.81 (2.02–3.91) 6.4 3.14 (1.75–5.61)
Ever injected drugs
No 15.9 1 2.1 1
Yes 39.1 3.40 (2.30–5.02) 9.7 4.97 (2.78–8.88)
First vaginal intercourse before 16 years
No 16.3 1 2.3 1
Yes 23.0 1.53 (1.19–1.97) 3.1 1.35 (0.89–2.04)
Ever had heterosexual anal sex
No 12.1 1 1.4 1
Yes 29.5 3.05 (2.46–3.79) 5.6 4.26 (2.87–6.32)
Table 5. Masturbation and other sexual activities in the past 12 months: comparison of the first Australian Study of Health and Relationships
(ASHR1) and the Second Australian Study of Health and Relationships (ASHR2)
People aged 60–69 years have been removed from the ASHR2 sample for comparison. BDSM, bondage and discipline, ‘sadomasochism’or dominance and
submission
Sexual activity Men Women
ASHR1
(n= 9696)
ASHR2
(n= 8518)
ASHR1
(n= 9387)
ASHR2
(n= 8753)
All respondents Mean Mean Difference (95% CI)
A
Mean Mean Difference (95% CI)
A
Mean no. of times masturbated in past 4 weeks 2.89 3.84 0.95 (0.57–1.34) 0.68 0.85 0.17 (0.03–0.31)
% % OR (95% CI)
B
% % OR (95% CI)
B
Masturbated in the past 12 months 64.6 76.6 1.80 (1.54–2.09) 34.9 44.7 1.51 (1.31–1.73)
Watched an X-rated movie 37.4 33.7 0.85 (0.74–0.98) 15.7 10.6 0.63 (0.52–0.77)
Used a sex toy
C
11.8 15.5 1.37 (1.13–1.66) 14.1 24.2 1.95 (1.63–2.32)
Respondents with a sexual partner in the past 12 months
Met new partner via an Internet chat room (ASHR1)
or via the Internet (ASHR2)
1.0 2.9 2.94 (2.04–4.26) 0.3 1.5 4.94 (2.60–9.38)
Paid for sex 1.9 2.4 1.24 (0.92–1.68)
Role play or dressing up 4.0 8.3 2.18 (1.58–3.02) 3.7 9.1 2.62 (1.89–3.64)
BDSM 2.0 2.8 1.42 (0.94–2.14) 1.4 1.8 1.29 (0.70–2.38)
Group sex 2.3 2.1 0.91 (0.66–1.23) 0.6 0.6 0.96 (0.55–1.67)
Digital anal stimulation 17.3 22.2 1.22 (1.02–1.45) 14.3 16.2 1.16 (0.94–1.43)
Fisting 0.6 0.8 1.40 (0.67–2.93) 0.5 0.6 1.23 (0.43–3.49)
Rimming 5.5 8.2 1.54 (1.20–1.96) 3.3 4.4 1.35 (0.95–1.92)
A
Unadjusted difference in means and 95% confidence intervals (CI) for ASHR2 versus ASHR1.
B
Unadjusted odds ratios (OR) and 95% CI for ASHR2 versus ASHR1.
C
Examples include a vibrator or dildo.
468 Sexual Health J. Richters et al.
In our data, for men, masturbation appears to be more clearly
related to the lack of a live-in partner, which is in line with the
notion of Kinsey et al.
34
of ‘outlet’. This association has also
been reported recently in a survey of Americans aged
18–39 years.
35
It is perhaps this view of masturbation as a
second best practice that ‘ought not’to be necessary if a partner
is available that makes solitary masturbation by someone in a
relationship distressing to the partner, a concern frequently
raised in internet forums and in couple therapy.
Masturbation is a sensitive topic and some people may have
preferred not to answer the question, particularly if they did not
see its relevance to health. They might also have said ‘No’or
refused to answer for fear that follow-up questions would ask
for details. Nonetheless, the overall refusal rate was under 3%
(1.7% of men and 3.4% of women refused or said they did not
know or could not remember). Indeed, the refusal rate was
considerably lower than for the question on income (8.3%),
a question routinely asked in commercial, social and political
surveys.
Looking at a range of practices, the largest differences
between men and women are for autoerotic activities:
masturbation and looking at pornography, including watching
X-rated movies. Also, far more men reported group sex. About
twice as many men reported using the Internet or a phone app to
look for partners, having online sex, meeting a new partner on
the Internet, and rimming. In theory, for heterosexual activities,
approximately the same numbers of men and women should
report each practice unless a few women are doing them with
multiple men. Sex work might account for some of this, as
2.3% of men reported paying for sex in the past year. Another
possibility is that much of the excess may be men reporting sex
with other men. Both men who have sex with men and women
who have sex with women have higher rates of masturbation
(Table 2) and more varied sexual practices, and bisexuals have
more other-sex partners than do heterosexuals.
1
However, an
analysis excluding people with same-sex partners in the
past year yielded very similar results (data available from
corresponding author). Although homosexually active men
account for approximately one percentage point excess
among the men for using the Internet or a phone app to look
for partners, meeting a new sexual partner via the Internet and
rimming, this is not enough to account for the male excess
overall. Thus most of the excess must be attributed largely to
men’s tendency to over-report sexual practices or women’s
tendency to under-report them.
1
This suggests that any social
desirability pressure on men is encouraging them not to present
a‘respectable’face to the interviewers, but rather to display a
wider sexual repertoire.
Gender differences were much smaller for some partnered
sexual activities. There was no significant difference for using a
sex toy with a partner, role play/dressing up or fisting. Given that
some heterosexual couples may practise insertion of the whole
hand into the vagina without knowing the term ‘fisting’, which is
more commonly used in the gay community, the practice is
probably underreported and it would not have been surprising if
there were an excess of male reports. Very few people (0.2%)
reported swinging. Despite attempts in the media to claim that
swinging is suddenly back in fashion,
36
it seems that it is very
much a minority practice.
As in ASHR1,
22
it is likely that the survey under-sampled
people, especially women, who had done sex work, or that
respondents were unwilling to report it. The results for men who
have paid for sex are more convincing. Men who pay for
sex, apart from being more likely to lack a regular partner,
appear more sexually motivated (e.g. more of them had first
intercourse before 16 years), with wider repertoires, and be
seekers of bodily pleasures in general (higher alcohol use,
injecting drugs). There seems to be no relationship between
the legality of sex work, which varies between states and
territories, and whether it happens.
37
The differences between
states are likely to be driven by the supply of potential
workers (influenced by population levels of education, job
availability and immigration), and specific local needs such
as high proportions of single men (e.g. in mining, in Western
Australia and the Northern Territory). The pattern of Australian
men’s use of sex workers is similar to the only other comparable
survey, Natsal, conducted in Britain, which found a higher
proportion of single men, sexually adventurous men and
users of alcohol and drugs among those who had paid for sex.
11
Changes since ASHR1
The general question about use of pornography in any medium
(Internet, film, print etc.) was not asked in ASHR1. The
proportion of people who had watched an X-rated movie had
dropped since the earlier survey; this probably reflects a shift
from viewing videos or DVDs to using the Internet. The
longitudinal study carried out from 2005 to 2010, between
ASHR1 and ASHR2,
38
provides evidence for this,
39
showing
a year-by-year reduction in the proportion of people viewing
X-rated movies and a corresponding increase in the use of
Internet sex sites.
The difference between the 9% in ASHR1 who said they
had been to an Internet sex site and the nearly half of ASHR2
respondents under 60 years who had ‘looked at pornography’is
striking. The extent to which easy access to visual pornography
is altering sexual attitudes and practices is unknown. It is
possible that Internet pornography is normalising practices
that were esoteric in the days before accessible filmed
pornography and partially responsible for the rise in anal
intercourse
1,8
and the other anal practices reported here. This
issue will be explored further in a separate paper.
Conclusions
Most of the solo practices studied were engaged in by more men
than women, but women were more likely to have used a sex toy.
Autoerotic activities are both substitutes for partnered sex and
additional sources of pleasure for people with sexual partners.
Telephone interviews can successfully elicit reports of less-
common and stigmatised sexual practices without offending
respondents.
Conflicts of interest
None declared.
Acknowledgements
This study was funded by the National Health and Medical Research Council
(grant number: 1002174). The authors are indebted to David Shellard and the
Masturbation, paying for sex, and other activities Sexual Health 469
staff of the Hunter Valley Research Foundation for managing data collection
and undertaking the interviews for this study, and to the Social Research
Centre for producing weights for the data. The authors also thank the 21 139
Australians who took part in the two phases of the project and so freely
shared the sometimes intimate aspects of their lives. Professor Anthony
Smith died during the course of this project and we intend this work to be a
tribute to, and further example of, the extraordinary contribution his work has
made to the sexual health and wellbeing of Australians.
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