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Unlabelled: 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 20094 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.
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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 1669 years
(participation rate among eligible people, 66.2%) were recruited by landline and mobile phone random-digit dialling and
computer-assisted telephone interviews in 201213. 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-fths 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 78%. Online sex, swinging, group sex, BDSM (bondage and discipline, sadomasochismor
dominance and submission) and sting (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 inuences 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,
35
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, 461471
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 reects concern about disease
transmission and sex between young people. As we remarked in
2003 when reporting the rst 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 1674 years had masturbated
in the past 4 weeks.
8
Similarly in a US probability-panel survey,
66% of men and 47% of women aged 1869 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 1644 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 kinkyor fetishsex.
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
Briey, between October 2012 and November 2013,
computer-assisted telephone interviews were completed by a
representative sample of 20 094 Australian men and women
aged 1669 years from all states and territories. Respondents
were selected using dual-frame modied 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 reect 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 nd 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 oralgenital 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 outof 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. Respondentsages were recoded
into six groups (1619, 2029, 3039, 4049, 5059 and
6069 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,otheror undecidedto allow analyses of
these groups. Respondentsreports of alcohol consumption
frequency and volume were used to determine whether their
consumption exceeded Australian National Health and Medical
Research Council 2001 guidelines.
14
Respondentsreports
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.
Respondentspostcodes 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 200910,
16
respondentsreports
of their annual household income were grouped into ve
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 Classication 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 signicant
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 specics 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
1669 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 identied using univariate
multinomial logistic regression. Correlates of continuous
outcomes were identied 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,lms,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 classied as movies containing only sexually explicit
contentfrom 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? Thats 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 ngers to stimulate a partners 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 sting? (Do not explain. Includes both receptive and insertive,vaginal and
rectal sting,if respondent asks which. Not asked if respondent has no experience of digital anal stimulation.)
Oralanal 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% condence 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.
1921
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 signicant, 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: 3.13.6) compared with less than once
a month (0.8 times, 95% CI: 0.70.9) for women (Table 1).
Among those who had masturbated in the previous 4 weeks, men
did so a mean of 6.3 times (CI: 5.96.7) and women 3.1 times
(CI: 2.93.4).
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%
condence 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 (0.250.32)
Dont remember 0.0 0.3
A
Refused 1.7 3.1 0.86 (0.591.26)
Masturbated in the past 4 weeks
Never 44.4 74.2 1
Less than once a week 26.7 18.5 0.41 (0.360.48)
13 times a week 19.7 5.4 0.16 (0.130.20)
46 times a week 2.9 0.3 0.07 (0.040.12)
Daily or more often 2.1 0.2 0.05 (0.030.09)
Dont remember 3.1 1.2 0.22 (0.120.41)
Refused 1.1 0.3 0.17 (0.080.37)
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 rst on an Internet site?
Box 3. Ascertainment of mens 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% condence 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)
1619 84.6 0.93 (0.571.51) 30.8 0.48 (0.320.71)
2029 85.6 1 48.3 1
3039 78.1 0.60 (0.400.92) 50.5 1.09 (0.811.48)
4049 75.0 0.51 (0.340.75) 48.5 1.00 (0.761.34)
5059 64.2 0.30 (0.210.44) 35.2 0.58 (0.440.77)
6069 46.0 0.14 (0.100.21) 26.5 0.39 (0.290.52)
Language spoken at home
English 73.2 1 43.6 1
Other 58.6 0.52 (0.360.74) 23.4 0.39 (0.250.63)
Sexual identity
Heterosexual 71.3 1 41.2 1
Homosexual 95.6 8.73 (4.4117.29) 70.2 3.36 (2.035.57)
Bisexual 94.8 7.28 (2.6020.39) 72.5 3.76 (2.196.44)
Education
Less than secondary 64.5 1 29.5 1
Secondary 73.8 1.55 (1.202.01) 40.3 1.62 (1.232.12)
Post-secondary 73.0 1.49 (1.161.92) 47.1 2.13 (1.682.70)
Religion
No 77.3 1 48.9 1
Yes 66.0 0.57 (0.470.68) 35.5 0.57 (0.480.68)
Region
Major city 73.3 1 43.6 1
Regional 68.3 0.79 (0.650.95) 39.1 0.83 (0.691.00)
Remote 75.0 1.09 (0.621.92) 57.1 1.73 (0.793.79)
Household income
$28 000 69.0 1 40.8 1
$28 001$53 000 68.2 0.96 (0.691.35) 38.7 0.92 (0.691.23)
$53 001$83 000 70.1 1.08 (0.781.50) 45.4 1.21 (0.911.60)
$83 001$125 000 73.9 1.27 (0.921.76) 45.3 1.20 (0.911.58)
>$125 000 78.2 1.62 (1.182.20) 47.7 1.32 (1.011.74)
Occupation
Blue collar 71.4 1 40.8 1
White collar 77.4 1.37 (1.061.78) 41.2 1.02 (0.741.36)
Manager/professional 69.4 0.91 (0.731.12) 45.4 1.21 (0.901.63)
Relationship status
No regular partner 88.8 1 45.4 1
Non-live-in regular partner 85.5 0.75 (0.441.27) 55.8 1.52 (1.102.08)
Live-in regular partner 66.7 0.25 (0.170.38) 39.0 0.77 (0.640.92)
No. of sexual partners in past year
None 68.9 1 33.5 1
One 68.9 1.00 (0.841.20) 41.4 1.41 (1.211.64)
Two or more 90.7 4.39 (3.415.66) 74.3 5.76 (4.527.33)
Looked at pornography
No 44.3 1 34.1 1
Yes 88.7 9.91 (7.9612.35) 74.9 5.75 (4.467.42)
Watched X-rated movie
No 66.4 1 40.2 1
Yes 85.8 3.07 (2.373.97) 68.4 3.22 (2.384.34)
Used a sex toy
A
in the past year
No 70.5 1 33.9 1
Yes 83.8 2.16 (1.582.95) 75.3 5.93 (4.687.52)
Digital anal stimulation in past year
No 69.9 1 40.3 1
Yes 86.8 2.83 (2.043.92) 64.8 2.74 (2.063.64)
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
rst 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
ndings are not directly comparable, as we do not know how
many people looked at pornography in non-Internet media in
200102.
Comparisons for identical or almost identical questions
are shown in Table 5. Signicant 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
ngering 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 ndings.
Solo masturbation is a common but not universal practice.
The sex differences in masturbation prevalence and frequency
are a robust nding across many studies.
810,19,23,24
Gender and
other sociodemographic differences in masturbation prevalence
suggest both a sexual interest or randinesselement and a
sociocultural inuence 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 Yesas a proportion of the total, which included No, Dont know/Cant 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% condence intervals (CI) are given for women versus men. BDSM, bondage and discipline,
sadomasochismor 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 (0.130.17)
Watched an X-rated movie (%) 31.0 9.0 0.23 (0.200.27)
Used a sex toy
A
(%) 14.5 20.7 1.80 (1.552.09)
Used the Internet or a phone app to look for partners (%) 7.0 3.8 0.52 (0.420.65)
Had online sex (%) 0.6 0.2 0.39 (0.210.71)
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 (0.390.73)
Used a sex toy
A
during sex with a partner (%) 13.8 15.9 1.18 (1.001.40)
Role play or dressing up (%) 7.3 8.3 1.15 (0.891.49)
BDSM (%) 2.5 1.6 0.63 (0.430.92)
Had group sex (%) 1.9 0.5 0.26 (0.170.40)
Swinging (%) 0.1 0.3 2.33 (1.065.16)
Digital anal stimulation (%) 18.6 15.2 0.78 (0.660.93)
Fisting (hand or st in vagina or rectum) (%) 0.7 0.5 0.73 (0.331.62)
Rimming (oral anal stimulation) (%) 7.4 4.1 0.50 (0.410.70)
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%
condence 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)
1619 2.8 0.22 (0.110.46) 1.3 0.45 (0.151.32)
2029 11.4 1 3.0 1
3039 16.4 1.52 (1.022.27) 2.7 0.91 (0.481.72)
4049 22.3 2.22 (1.543.20) 1.9 0.62 (0.341.12)
5059 19.0 1.83 (1.282.61) 2.4 0.80 (0.461.37)
6069 20.3 1.98 (1.382.84) 2.1 0.70 (0.381.28)
Language spoken at home
English 17.0 1 2.2 1
Other 12.8 0.72 (0.471.11) 3.2 1.44 (0.683.03)
Sexual identity
Heterosexual 16.6 1 2.3 1
Homosexual 14.3 0.83 (0.531.32) 1.2 0.53 (0.161.76)
Bisexual 22.9 1.49 (0.912.43) 4.0 1.78 (0.625.10)
Education
Less than secondary 17.6 1 1.9 1
Secondary 17.4 0.98 (0.741.32) 2.6 1.33 (0.752.50)
Post-secondary 15.8 0.88 (0.661.17) 2.3 1.21 (0.662.21)
Religion
No 17.7 1 2.6 1
Yes 15.8 0.88 (0.711.07) 2.1 0.79 (0.541.16)
Religious attendance
Never or less than monthly 17.5 1 2.5 1
At least monthly 13.1 0.71 (0.520.98) 1.4 0.54 (0.261.08)
Region
Major city 15.8 1 2.3 1
Regional 18.3 1.19 (0.961.49) 2.0 0.88 (0.541.45)
Remote 19.7 1.31 (0.742.31) 5.8 2.63 (1.046.67)
Household income
Very low 13.9 1 1.6 1
Low 18.1 1.37 (0.961.97) 4.1 2.68 (1.335.41)
Middle 17.2 1.28 (0.921.80) 2.8 1.82 (0.933.55)
High 17.9 1.35 (0.961.91) 2.0 1.30 (0.632.70)
Very high 17.4 1.31 (0.941.82) 1.6 1.05 (0.552.03)
Occupation
Blue collar 20.9 1 2.9 1
White collar 16.3 0.69 (0.520.91) 2.1 1.72 (0.441.18)
Manager/professional 16.8 0.86 (0.681.08) 2.1 0.70 (0.451.08)
Relationship status
No regular partner 25.1 1 11.3 1
Non-live-in regular partner 15.4 0.54 (0.370.79) 3.4 0.28 (0.160.49)
Live-in regular partner 16.2 0.58 (0.440.76) 1.0 0.08 (0.050.13)
Ever looked at pornography
No 4.8 1 0.5 1
Yes 19.1 4.73 (3.067.32) 2.8 6.29 (2.4216.37)
State/territory of residence
New South Wales 18.5 1 2.5 1
Victoria 14.1 0.72 (0.540.96) 2.0 0.81 (0.481.37)
Queensland 16.3 0.85 (0.641.14) 1.6 0.61 (0.331.13)
Western Australia 19.4 1.06 (0.761.48) 3.6 1.47 (0.822.61)
South Australia 12.0 0.60 (0.380.94) 2.3 0.93 (0.451.89)
Australian Capital Territory 19.3 1.06 (0.482.32) 2.2 0.87 (0.213.72)
Tasmania 9.5 0.46 (0.240.87) 1.9 0.73 (0.222.50)
Northern Territory 38.7 2.78 (1.276.07) 7.8 3.31 (0.6915.94)
(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 benets for
women in learning about their own bodies and negotiating more
rewarding sexual practice with partners.
2629
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 nding 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 womens 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 (2.023.91) 6.4 3.14 (1.755.61)
Ever injected drugs
No 15.9 1 2.1 1
Yes 39.1 3.40 (2.305.02) 9.7 4.97 (2.788.88)
First vaginal intercourse before 16 years
No 16.3 1 2.3 1
Yes 23.0 1.53 (1.191.97) 3.1 1.35 (0.892.04)
Ever had heterosexual anal sex
No 12.1 1 1.4 1
Yes 29.5 3.05 (2.463.79) 5.6 4.26 (2.876.32)
Table 5. Masturbation and other sexual activities in the past 12 months: comparison of the rst Australian Study of Health and Relationships
(ASHR1) and the Second Australian Study of Health and Relationships (ASHR2)
People aged 6069 years have been removed from the ASHR2 sample for comparison. BDSM, bondage and discipline, sadomasochismor 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 (0.571.34) 0.68 0.85 0.17 (0.030.31)
% % OR (95% CI)
B
% % OR (95% CI)
B
Masturbated in the past 12 months 64.6 76.6 1.80 (1.542.09) 34.9 44.7 1.51 (1.311.73)
Watched an X-rated movie 37.4 33.7 0.85 (0.740.98) 15.7 10.6 0.63 (0.520.77)
Used a sex toy
C
11.8 15.5 1.37 (1.131.66) 14.1 24.2 1.95 (1.632.32)
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 (2.044.26) 0.3 1.5 4.94 (2.609.38)
Paid for sex 1.9 2.4 1.24 (0.921.68)
Role play or dressing up 4.0 8.3 2.18 (1.583.02) 3.7 9.1 2.62 (1.893.64)
BDSM 2.0 2.8 1.42 (0.942.14) 1.4 1.8 1.29 (0.702.38)
Group sex 2.3 2.1 0.91 (0.661.23) 0.6 0.6 0.96 (0.551.67)
Digital anal stimulation 17.3 22.2 1.22 (1.021.45) 14.3 16.2 1.16 (0.941.43)
Fisting 0.6 0.8 1.40 (0.672.93) 0.5 0.6 1.23 (0.433.49)
Rimming 5.5 8.2 1.54 (1.201.96) 3.3 4.4 1.35 (0.951.92)
A
Unadjusted difference in means and 95% condence 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
1839 years.
35
It is perhaps this view of masturbation as a
second best practice that ought notto 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 Noor
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
mens tendency to over-report sexual practices or womens
tendency to under-report them.
1
This suggests that any social
desirability pressure on men is encouraging them not to present
arespectableface to the interviewers, but rather to display a
wider sexual repertoire.
Gender differences were much smaller for some partnered
sexual activities. There was no signicant difference for using a
sex toy with a partner, role play/dressing up or sting. Given that
some heterosexual couples may practise insertion of the whole
hand into the vagina without knowing the term sting, 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 rst
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 (inuenced by population levels of education, job
availability and immigration), and specic local needs such
as high proportions of single men (e.g. in mining, in Western
Australia and the Northern Territory). The pattern of Australian
mens 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, lm, 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 reects 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 pornographyis
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 lmed
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.
Conicts 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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www.publish.csiro.au/journals/sh
... In the European Male Ageing Study, a population-based survey of 3369 men (40-79 years) from eight European countries, masturbation reported at least once in the past month decreased from 36% in the age cohort 60-69 years to 25% among men aged 70 and above (Corona et al., 2010). Apart from age, research has revealed important gender differences, with women generally reporting less masturbation than men (Kontula & Haavio-Mannila, 2003;Lee et al., 2016;Lindau et al., 2007;Oliver & Hyde, 1993;Palacios-Ceña et al., 2012;Papaharitou et al., 2008;Richters et al., 2014). For example, in the most recent wave of the population-based British National Survey of Sexual Attitudes and Lifestyles, more than twice as many men (53%) in the age group 55-64 years reported masturbating in the past month than women (19%) (Mercer et al., 2013). ...
... Higher levels of education may be associated with masturbation through better access to information, health literacy, and sex education, which possibly diminish negative assumptions and fears related to masturbation (Gerressu et al., 2008;Kontula & Haavio-Mannila, 2003;Richters et al., 2014). For instance, Kontula and Haavio-Mannila (2003) found that Finns with higher levels of education felt less guilt about masturbation, perceived masturbation less often as unhealthy, and masturbated more often than those with lower levels of education. ...
... Overall, more sociodemographic factors were predictive of men's masturbation than women's. As found by others (Corona et al., 2010;Lee et al., 2016;Lindau et al., 2007;Mercer et al., 2013;Palacios-Ceña et al., 2012;Richters et al., 2014;Schick et al., 2010), older age was negatively associated with masturbation in Norwegian, Danish, and Belgian men, and Danish women. However, as with previous cross-sectional data, it was not possible to assess whether this reflected an age or cohort effect. ...
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Despite its relevance for human sexuality, literature on potential effects of ejaculation frequency and masturbation on general and mental health outcomes is sparse. Reasons for this knowledge gap include a general lack of interest, but also methodological challenges and still existing superstition. This paper reconciles literature from various fields to extract relevant information on how ejaculation frequency effects general and mental health outcomes. Culture-bound syndromes have been reported in countries still strictly tabooing or condemning masturbation. Masturbatory guilt describes a phenomenon in individuals experiencing a discrepancy between moral standards and own behavior with respect to masturbation. Abstinence is one aspect under study in the area of fertility treatment. Specific time frames and their respective implications on quality of sperm remain inconclusive. Limited temporal resolution capacities hamper the precise study of brain structures directly activated during ejaculation. The relation between ejaculation frequency and hormonal influences remains poorly understood. Future research that specifically addresses ejaculation frequency and potential mental and general health outcomes is needed. In contrast to extracting knowledge as a byproduct from other studies with a different focus, this enables sound study designs and could provide evidence-based results which could then be further discussed and interpreted.
... Purchasing sex is typically associated with men, as women report low rates of purchasing sex. In a study of over 10,000 participants, Richters et al. (2014) reported that only approximately 0.3% of women self-reported purchasing sex at any point in their lifetime, compared to 16.7% of men. A more recent study estimated that one of every 25 men (4%) in the U.S. had bought sex, with approximately 4 million men purchasing sex annually (Roe-Sepowitz et al., 2019), underscoring the prevalence of the commodification or purchasing of sex by men in the United States. ...
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... A separate issue pertains to the indicator used to measure sexual variety. Although our study covered a diverse array of acts of sexual variety, incorporating similar sexual behaviors as those measured in previous studies (Frederick et al., 2017;Herbenick et al., 2017;Richters et al., 2014), the list of sexual acts is not nearly exhaustive. ...
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The purpose of this study was to examine Norwegians' reports of seven varied sexual acts. Data were obtained from a questionnaire survey of a probability-based web sample of 2,181 men and 1,967 women aged 18-89 years. Among seven acts of sexual variety, the most common sexual experiences were trying to watch pornography with a partner, engaging in sex in unusual places, and using sex toys. Older age was negatively associated with all sexual behaviors. Regarding more unorthodox acts of sexual variety, heterosexual men's sexual preferences involved having and desiring group sex, whereas heterosexual women's sexual experiences and desires involved having sex in unusual places. Lesbian, gay, bisexual (LGB) individuals generally showed greater curiosity or experience of having group sex and engaging in BDSM (bondage, discipline, dominance and submission, and sadomasochism) activities than heterosexual adults. However, while LGB men had a high preference for group sex activities, LGB women had more positive attitudes toward BDSM activity. Individuals appear to accumulate more acts of sexual variety over time, thus making the incorporation of sexual variety a function of age. This study supports the idea that sexual variety has expanded among those born from 1960 onwards.
... Since the 1980s, these and other sexual behaviors previously relegated to the 'Outer Limits' (e.g., anal sex, vibrator use, dominant/submissive sex) have become prevalent among adults in the U.S. and other Western countries. [28][29][30][31][32][33][34][35][36] Choking/strangulation is one such behavior that appears to have moved more into the mainstream in the past 20 years. 13,19,37 A 2003/2004 convenience survey of lesbian, gay, and bisexual (LGB) individuals in New York City found that 8% of gay and bisexual men participants had engaged in "breath play/asphyxiation" 38 as had 5% of lesbian and bisexual women participants. ...
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The aim of this study was to investigate the association between masturbation frequency and sexual dysfunction among men and women, focusing on individuals with and without regular sexual partners, and to determine whether sexual compatibility (e.g., similar sexual desire levels and a match between desired behaviors and behaviors one’s partner is willing to engage in) in the relationship affects masturbation frequency. Here, 12,271 Finnish men and women completed an online survey about masturbation frequency, sexual function, and sexual compatibility with their partner for those who were in a relationship. The results indicated that masturbation frequency was positively associated with overall sexual function for women. This was moderated by relationship status, meaning that more frequent masturbation was associated with better orgasmic function and sexual satisfaction in single women, whereas the opposite was true for women who were in a relationship. For men, more frequent masturbation was associated with better erectile function for single men, and better ejaculatory latency but worse orgasmic function, intercourse satisfaction, and more symptoms of delayed ejaculation for men who were in a relationship. Lower sexual compatibility and sexual dysfunctions in the partner were associated with more frequent masturbation in both sexes. The associations between masturbation frequency and sexual function vary for single and partnered individuals, and are, for the latter group, further affected by sexual compatibility.
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Background and objectives Recent years have seen a surge of articles related to compulsive pornography consumption or pornography addiction, with experts warning of potentially detrimental consequences. Whereas much research has focused on the male consumers of pornography, fewer studies have examined the impacts of pornography-linked compulsive sexual behaviors (CSBs) on the wellbeing and experiences of female intimate partners. This paper addresses this gap in the literature. Methods A review of peer-reviewed journal publications was carried out examining pertinent quantitative and qualitative studies. Results and discussion This narrative review concludes that compulsive pornography consumption is commonly identified in the literature as a stimulus for risky and uncontrolled sexual behaviors, which have the potential to spawn addictive behaviors, relationship challenges and cascading adverse societal repercussions. In synthesis, this review points to opportunities for in-depth qualitative empirical research on intimate female partner wellbeing.
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According to previous research, interest in BDSM (Bondage-Discipline, Dominance-Submission and Sadomasochism) activities is high in several European countries and various BDSM practices are not uncommon. There is a limited amount of research on the personalities of BDSM practitioners, but in previous research practitioners have been found to have better overall well-being and to be more educated than the general population. The current study explored the prevalence of BDSM interest and practice in a Finnish sample (n = 8,137, age range 18–60, M = 30.14, SD = 8.08) and investigated the association between BDSM interest and personality measured with the six-factor personality measure HEXACO. A total of 38% of the sample was interested in BDSM sex and non-heterosexual individuals displayed almost twice as much interest and at most 83% more participation in BDSM than heterosexual individuals. Younger participants (18–28 years old) displayed almost three times as much interest than older participants. There were some associations between BDSM interest and personality factors, but the effect sizes of these associations were modest. The study shows that BDSM interest is quite common among the Finnish population.
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The Australian Study of Health and Relationships is a large national population-representative survey of sexual behavior and attitudes conducted every decade. We describe experiences of sexual difficulties lasting at least a month among Australians surveyed in 2012-2013 and identify changes since the previous survey in 2001-2002. Computer-assisted telephone interviews were completed by 20,091 people aged 16-69 (participation rate 66%) of whom 16,897 people had had sex with a partner in the previous year. We asked how long each difficulty lasted, whether it was a problem and whether they sought treatment. Half (48%) the men and 68% of women reported at least one difficulty. Lack of interest in having sex was common (28% men, 52% women); 21% of men reported coming to orgasm "too quickly," and women reported inability to reach orgasm (25%) and trouble with vaginal dryness (22%). Women were more likely than men not to find sex pleasurable and to have physical pain during intercourse. Some differences by age group were also apparent. Many difficulties were not seen as problems, especially lacking interest and reaching orgasm too quickly. People with erection/dryness problems, or with pain in intercourse, were more likely to seek treatment, as were people with multiple difficulties. Between 2001-2002 and 2012-2013 there was little change for men, but among women rates of all sexual difficulties fell by 4-10 percentage points. This change accompanied a drop in frequency of sex among people in ongoing relationships and an increase in masturbation and use of pornography. One explanation might be that, over time, fewer women were agreeing to "service sex" when they were not in the mood. Overall, the drop in prevalence of women's sexual difficulties since a decade earlier suggests a change towards more egalitarian sexual relations.
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Unlabelled: Background Current information about numbers of other-sex partners, experiences of different heterosexual behaviours and the recent heterosexual experiences among a representative sample of Australian adults is needed. It is not known whether these practices have changed between 2001-02 and 2012-13. Methods: Computer-assisted telephone interviews were completed by a representative sample of 9963 men and 10131 women aged 16-69 years from all states and territories. The overall participation rate among eligible people was 66.2%. Results: Men reported more sexual partners than women, although the lifetime number of heterosexual partners reported by women increased significantly between 2001-02 and 2012-13. In 2012-13, 14.7% of men and 8.6% of women reported two or more sexual partners in the last year. Reporting multiple partners was significantly associated with being younger, being bisexual, living in major cities, having a lower income, having a blue-collar occupation and not being married. The proportion of respondents reporting ever having had oral sex or anal intercourse increased significantly since the last survey. At the last heterosexual encounter, 91.9% of men and 66.2% of women had an orgasm, oral sex was reported in only approximately one in four encounters and anal intercourse was uncommon. Conclusion: There were increases between 2001-02 and 2012-13 in partner numbers among women and in the lifetime experience of oral and anal sex. The patterns of heterosexual experience in Australia are similar to those found in studies of representative samples in other countries.
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Unlabelled: Background This paper describes the methods and process of the Second Australian Study of Health and Relationships. Methods: A representative sample of the Australian population was contacted by landline and mobile phone modified random-digit dialling in 2012-13. Computer-assisted telephone interviews elicited sociodemographic and health details as well as sexual behaviour and attitudes. For analysis, the sample was weighted to reflect the study design and further weighted to reflect the location, age and sex distribution of the population at the 2011 Census. Results: Interviews were completed with 9963 men and 10131 women aged 16-69 years from all states and territories. The overall participation rate among eligible people was 66.2% (63.9% for landline men, 67.9% for landline women and 66.5% for mobile respondents). Accounting for the survey design and adjusting to match the 2011 Census resulted in a weighted sample of 20094 people (10056 men and 10038 women). The sample was broadly representative of the Australian population, although as in most surveys, people with higher education and higher status occupations were over-represented. Data quality was high, with the great majority saying they were not at all or only slightly embarrassed by the questionnaire and almost all saying they were 90-100% honest in their answers. Conclusions: The combination of methods and design in the Second Australian Study of Health and Relationships, together with the high participation rate, strongly suggests that the results of the study are robust and broadly representative of the Australian population.
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Unlabelled: Background The aim of this study is to describe homosexual experience and characteristics of recent homosexual encounters among Australian adults and identify changes between 2001-02 and 2012-13. Methods: Computer-assisted telephone interviews were completed by a representative sample of 20094 men and women aged 16-69 years and the participation rate among eligible people was 66.2%. Respondents indicated the number of same-sex partners they had had in their lifetime and in the last 12 months. Those who reported any homosexual experience were asked the age at which this first occurred and about characteristics of the first and most recent homosexual encounter. Results: Reporting ever having same-sex experience was more common in women (13.5%) than in men (6.5%, P<0.001). Among these people, men reported more lifetime and recent same-sex partners than women (P<0.001). Same-sex experience was associated with some but not all indices of higher socioeconomic status. In men, it was associated with living in a major city (P=0.02) and in women, it was associated with younger (<30 years) age and with very low income (P<0.001). Men were younger than women at their first homosexual encounter (P=0.005). Women were more likely than men to have their first same-sex encounter with a regular partner. For women but not men, there was a significant increase in the proportion reporting same-sex experience since 2001-02. Conclusion: Same-sex experience is not uncommon and is increasing in prevalence in young Australian women. The high number of same-sex partners among homosexual and bisexual men places them at greater risk of sexually transmissible infection.
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Sexual behaviour and relationships are key components of wellbeing and are affected by social norms, attitudes, and health. We present data on sexual behaviours and attitudes in Britain (England, Scotland, and Wales) from the three National Surveys of Sexual Attitudes and Lifestyles (Natsal). We used a multistage, clustered, and stratified probability sample design. Within each of the 1727 sampled postcode sectors for Natsal-3, 30 or 36 addresses were randomly selected and then assigned to interviewers. To oversample individuals aged 16-34 years, we randomly allocated addresses to either the core sample (in which individuals aged 16-74 years were eligible) or the boost sample (in which only individuals aged 16-34 years were eligible). Interviewers visited all sampled addresses between Sept 6, 2010, and Aug 31, 2012, and randomly selected one eligible individual from each household to be invited to participate. Participants completed the survey in their own homes through computer-assisted face-to-face interviews and self-interview. We analysed data from this survey, weighted to account for unequal selection probabilities and non-response to correct for differences in sex, age group, and region according to 2011 Census figures. We then compared data from participants aged 16-44 years from Natsal-1 (1990-91), Natsal-2 (1999-2001), and Natsal-3. Interviews were completed with 15 162 participants (6293 men, 8869 women) from 26 274 eligible addresses (57·7%). 82·1% (95% CI 81·0-83·1%) of men and 77·7% (76·7-78·7%) of women reported at least one sexual partner of the opposite sex in the past year. The proportion generally decreased with age, as did the range of sexual practices with partners of the opposite sex, especially in women. The increased sexual activity and diversity reported in Natsal-2 in individuals aged 16-44 years when compared with Natsal-1 has generally been sustained in Natsal-3, but in men has generally not risen further. However, in women, the number of male sexual partners over the lifetime (age-adjusted odds ratio 1·18, 95% CI 1·08-1·28), proportion reporting ever having had a sexual experience with genital contact with another woman (1·69, 1·43-2·00), and proportion reporting at least one female sexual partner in the past 5 years (2·00, 1·59-2·51) increased in Natsal-3 compared with Natsal-2. While reported number of occasions of heterosexual intercourse in the past 4 weeks had reduced since Natsal-2, we recorded an expansion of heterosexual repertoires-particularly in oral and anal sex-over time. Acceptance of same-sex partnerships and intolerance of non-exclusivity in marriage increased in men and women in Natsal-3. Sexual lifestyles in Britain have changed substantially in the past 60 years, with changes in behaviour seeming greater in women than men. The continuation of sexual activity into later life-albeit reduced in range and frequency-emphasises that attention to sexual health and wellbeing is needed throughout the life course. Grants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health.
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The addiction model is rarely used to describe high frequency use of Visual Sexual Stimulus (VSS) in research, yet it is commonly used in media and clinical practice. The theory and research behind “pornography addiction” is hindered by poor experimental designs, limited methodological rigor, and lack of model specification. The history and limitations of addiction models are reviewed, including how VSS fail to meet standards of addiction. These include how VSS use can reduce health risk behaviors. Proposed negative effects, including erectile problems, difficulty regulating sexual feelings, and neuroadaptations are discussed as non-pathological evidence of learning. Individuals reporting “addictive” use of VSS could be better conceptualized by considering issues such as gender, sexual orientation, libido, desire for sensation, with internal and external conflicts influenced by religiosity and desire discrepancy. Since a large, lucrative industry has promised treatments of pornography addiction despite this poor evidence, scientific psychologists are called to declare the emperor (treatment industry) has no clothes (supporting evidence). When faced with such complaints, clinicians are encouraged to address behaviors without conjuring addiction labels.
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A stratified probability sample survey of the British general population, aged 16 to 44 years, was conducted from 1999 to 2001 (N = 11,161) using face-to-face interviewing and computer-assisted self-interviewing. We used these data to estimate the population prevalence of masturbation, and to identify sociodemographic, sexual behavioral, and attitudinal factors associated with reporting this behavior. Seventy-three percent of men and 36.8% of women reported masturbating in the 4 weeks prior to interview (95% confidence interval 71.5%-74.4% and 35.4%-38.2%, respectively). A number of sociodemographic and behavioral factors were associated with reporting masturbation. Among both men and women, reporting masturbation increased with higher levels of education and social class and was more common among those reporting sexual function problems. For women, masturbation was more likely among those who reported more frequent vaginal sex in the last four weeks, a greater repertoire of sexual activity (such as reporting oral and anal sex), and more sexual partners in the last year. In contrast, the prevalence of masturbation was lower among men reporting more frequent vaginal sex. Both men and women reporting same-sex partner(s) were significantly more likely to report masturbation. Masturbation is a common sexual practice with significant variations in reporting between men and women.
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Much research into young people's developing sexuality is concerned with risk avoidance and the reduction of negative outcomes. Little research has been conducted into sexual self-exploration and, in particular, masturbation among young people, and this has generally been concerned merely with its prevalence. Little is known about the potential role of masturbation in relation to young people's developing sexuality, especially among young women. This study aimed to explore, using a qualitative approach, how young women reported their experiences of masturbation and whether and how these related to other aspects of their sexual activity. Thematic analysis of interview transcripts was employed to identify the range of reported experiences across participants, as well as the relations between various aspects of sexual development and experiences within participants. The findings revealed a broad continuum of views and opinions on female masturbation, which had strong links with parent and partner communication and the young women's beliefs and values concerning their sexual selves. The article concludes by drawing attention to the apparent relation between positive early childhood communication, young women's positive views of their sexual self, and their subsequent sexual activity
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One hundred online sexual health forum pages were analyzed to identify sexual health concerns of young people. Pages collected from five popular forum Web sites posted in August 2011 were indexed, noting demographics, primary complaint, type of question and response, misconceptions of medical concepts, and general keywords. Gaps in knowledge were identified regarding tampon use, menstrual fluid, hormonal contraception, sexually transmitted infections, and signs of pregnancy. Forum participants searched online using symptoms, a finding that suggests Web sites providing sexual health information to young people should be organized by symptom. Sex education should inform students about transmission risks associated with common sexual practices rather than focusing on diseases and should teach how to find and access local services.