A Global Survey of Sexual Behaviours

Abstract

Objective: To identify the variety of sexual behaviours undertaken by adults across the world. Materials and methods: A global survey was undertaken using the internet to access 26,032 participants across 26 countries that completed a set of questions on line.Results: Three in five people agreed that sex was important to them with nearly one in three strongly agreeing with the statement. Sex was important for both men and women and remains important as people grow older. Sixty nine percent of respondents agreed that sex is fun and that they enjoyed sex. Two thirds agreed that "a good sex life is a vital part of life" of which a third strongly agreed. In addition 56% of non-sexually active individuals agreed with the statement. Two thirds agreed that "sex is beneficial for your health and well being" of which a third strongly agree. Fifty three percent of non-sexually active people agreed as well. Conclusion: Sex is important for people and contributes to their overall global well being.

Full text


Journal of Family and Reproductive Health Journal Vol.3 No.2 June 2009
39
A Global Survey of Sexual Behaviours
Kevan Wylie, M.B., M.D., DSM, FRCP, FRCPsych
Porterbrook Clinic, Sheffield, UK
Received February 2009; Revised and accepted April 2009
Introduction
1
Sex is important to people. Whether this happens in
the bedroom or elsewhere, sexual activity is as
important to many people as having a good night’s
sleep, a healthy diet, a good recreational life and a
fulfilling vocation. Despite this many people express
dissatisfaction with their relationship and 40% of
men and 20% of women admit to having an
extramarital or extra partnership affair sometime in
their lifetime (1). In the United States between 20 and
25% admit to having one or more affairs during their
lifetime (2) and this has remained consistent over a
decade (3). There are differences between men and
Correspondence :
Kevan Wylie, Porterbrook Clinic, 75, Osborne Road, She_eld. S11
9BF. UK.
Tel: 0114 271 8674
E-mail: k.r.wylie@sheffield.ac.uk
women and between individuals between countries.
Whether this is due to differences in genetic loading,
differences in androgen levels, neuropsychological
changes or the effect of religion or culture, it has
been recognised that there are considerable
differences across countries although the reasons for
these are not clear.
The basic definitions of sex were revisited by an
expert group (PAHO 2000) with sex, sexuality and
sexual health defined. Sexual health can be identified
through the free and responsible expressions of
sexual capabilities that foster harmonious personal
and social wellness, enriching life within an ethical
framework. This has the potential to allow a more
directed focus in promoting sexual health in general
(4).
Several studies have attempted to assess sexual
satisfaction. 4000 adults registered with general
practices in the North of England were reported in the
study by Dunn et al (5). A quarter of the respondents
said that that they were dissatisfied with their sex life
Abstract
Objective:
Objective:Objective:
Objective: To identify the variety of sexual behaviours undertaken by adults across the world.
Materials and methods:
Materials and methods:Materials and methods:
Materials and methods: A global survey was undertaken using the internet to access 26,032
participants across 26 countries that completed a set of questions on line.
Results:
Results:Results:
Results: Three in five people agreed that sex was important to them with nearly one in three strongly
agreeing with the statement. Sex was important for both men and women and remains important as
people grow older. Sixty nine percent of respondents agreed that sex is fun and that they enjoyed sex.
Two thirds agreed that “a good sex life is a vital part of life” of which a third strongly agreed. In addition
56% of non-sexually active individuals agreed with the statement. Two thirds agreed that “sex is
beneficial for your health and well being” of which a third strongly agree. Fifty three percent of non-
sexually active people agreed as well.
Conclusion:
Conclusion:Conclusion:
Conclusion: Sex is important for people and contributes to their overall global well being.
Key words:
Key words:Key words:
Key words:
Global survey, Sexual behaviour, Well being

Kevan Wylie

Journal of Family and Reproductive Health Journal Vol.3 No.2 June 2009
40
particularly more so for men around the frequency of
intercourse. The respondents were more likely to be
dissatisfied with their sex lives if they perceived that
their partner also had a sexual problem. The respondents
who were dissatisfied were much more likely to report
that their partner was also dissatisfied with their sex life.
The benefits of treating sexual problems therefore have
the benefit for both partners.
One in four women in a study by Bancroft et al (6)
involving 987 women aged 20-65 years of age
reported marked distress about their sexual
relationship or their own sexuality. A stronger
relationship existed between sexual distress and
emotional wellbeing.
The Global Study of Sexual Attitudes and
Behaviours surveyed 27,500 men and women aged
40-80 years of age in 29 countries (7). This survey
reported relationship between subjective sexual
wellbeing and various predictors and outcomes of
sexual behaviour including overall happiness. Sexual
wellbeing was assessed in term of satisfaction
judgements across different domains including
physical and emotional aspects of relationships,
sexual functioning, and the relative importance that
sexuality played in the individual’s lives. The four
aspects of sexual wellbeing were physical pleasure,
emotional pleasure, satisfaction with sexual function
and importance of sex. Three clusters of countries
were grouped as one – Western Europe, Canada and
Australia with high satisfaction and four in five
women reporting satisfaction with their level of
sexual function. In this group half of the men and a
third of the women reported sex as extremely or very
important for their overall life satisfaction. Cluster
two including Egypt, Morocco, Italy, Korea and
Malaysia reported moderate levels of satisfaction
with significantly lower levels of emotional, physical
and sexual function satisfaction. The third cluster
included China, Indonesia, Japan and Thailand with
the lowest levels of emotional and physical
satisfaction. This group also attributed the least
importance to sex in their overall lives. The overall
conclusions across all of the groups was that sexual
wellbeing was positively related to both physical and
mental health, sexual activity levels and the context
of the relationship. Men had consistently higher
scores than women on all measures of sexual
satisfaction in all of the countries with differences
between men and women greater in the more male
centred clusters two and three. Physical and
emotional satisfactions were strong predictors of
overall happiness in men and women in all three
clusters with the effects strongest for women.
Six in ten of 1700 respondents in the American
Association of Retired Persons (AARP) survey
reported a belief that sexual activity was an essential
element in satisfactory relationships. This survey
involved adults aged 45 and older. For many women
in the survey, the use of ED medications by their
partner had brought about an enhancement of their
own sexual satisfaction (8, 9).
In a group of older men and women in the US aged
57-74 (10) more than half of the respondents
continually to be sexual active and rated sexual
activity important in their lives. Overall older women
reported more frequent problems and lower rates of
sexual satisfaction overall than men which confirmed
similar studies to the study by Laumann et al (11).
Materials and methods
The Sexual Well Being Global Survey (SWGS)
involved 26,032 respondents world wide from 26
Table
TableTable
Table1
11
1:
Countries involved and number of participants
Country Number of
participants
Australia 1036
Austria 542
Brazil 1123
Canada 1005
China 1132
France 1137
Germany 1037
Greece 1017
Holland 1039
Hong Kong 1129
India 1000
Italy 1013
Japan 1090
Malaysia 1026
Mexico 1122
New Zealand 1143
Nigeria 500
Poland 1050
Russia 1042
Singapore 1021
Spain 1008
Switzerland 557
UK 1017
USA 1005

Survey of sexual behaviours
Vol. 3, No. 2, June 2009 Journal of Family and Reproductive Health

41
countries. The survey was conducted electronically
(on the internet) over a seven week period between
August and September 2006 and carried out by Harris
international, a large market research agency. The
exception was in Nigeria where the survey was done
by face-to-face interview. A number of questions
were asked of respondents and all questions had to be
completed for the data set to be accepted into the
database. The countries involved and number of
participants is shown in table one.
Results
In total 26,032 respondents participated in the study
world wide. The minimal age was 16. 12966 (49.8%)
were women. With regards to sexual orientation 90%
reported being heterosexual, 2% gay, 1% lesbian and
3% bisexual with a further 4% declining to answer.
The respondents from the majority of countries
agreed or strongly agreed to the statement that “sex is
beneficial for your general health and well being”.
These are represented in table 2.
Sexual satisfaction
Just 44% of all participants were very or extremely
satisfied with their sexual life. It was similar for both
men and women. Up to the age of 25, levels of full
satisfaction were greater for men than for women. As
people aged beyond 34 years more women than men
continued to be fully satisfied with their sex lives. A
decline in the frequency of sex with age was noted in
the percentage having sex weekly (table 3).
For both men and women full satisfaction is
achieved when in a relationship regardless of whether
they were cohabiting, but were not married. Full
satisfaction levels in men were more likely than
women to decrease as the commitment increases.The
full satisfaction being higher for men when not
cohabiting (54% versus 47%) than for women when
married (45% versus 40%). The highest levels of full
satisfaction were seen in Nigeria, Mexico, India and
Poland with the lowest levels of full satisfaction
being described in Japan, France and Hong Kong
(table 4).
A range of activities “in the bedroom”
Participants were asked to respond about
intercourse, foreplay, oral sex, anal sex, vaginal sex,
solo or mutual masturbation, other activities and
products used whether alone or together (vibrators,
lubricants and various delay sprays). Having sex
included masturbation alone for 21% of participants,
with their partner for 30% of participants, oral sex for
38% of participants and for 9% of participants it did
Table 2:
Table 2:Table 2:
Table 2: Agreeing or strongly agreeing that “sex is
beneficial for your general health and well being”
Country
Agreeing or strongly
agreeing that “sex is
beneficial for your
general health and well
being” (%)
Brazil 91
Greece 86
Poland 84
Mexico 84
Spain 81
Russia 78
Malaysia 72
Switzerland 71
Austria 70
India 69
South Africa 67
Canada 66
Germany 66
Netherlands 66
China 66
France 65
USA 63
Australia 61
Italy 60
New Zealand 59
Nigeria 56
Singapore 51
Hong Kong 50
UK 48
Japan 30
Thailand 28
Table 3
Table 3Table 3
Table 3: Fully Satisfied percentage and frequency
of sex
Age (year) Fully
Satisfied (%) Having sex
weekly (%)
16-19 53 55
20-24 49 70
25-34 49 71
35-49 42 65
50-64 50 39
65+ 42 40

Kevan Wylie

Journal of Family and Reproductive Health Journal Vol.3 No.2 June 2009
42
not include penetrative sex. There was a high
prevalence of oral sex across groups. Anal sex was
high amongst groups other than homosexual males.
The range of sexual activities for heterosexual men
and women, gay men, lesbian women and bisexual
men and woman is shown in table 5.
Table
4
: Satisfaction of the participitants
Country 16% dissatisfied
(somewhat/very/ extremely
dissatisfied)
37% middle of the
ground/neutral
(neither/ nor/ somewhat
satisfied)
44% full satisfied
(very/ extremely
satisfied)
Nigeria 31 67
Mexico 10 26 63
India 11 27 61
Poland 11 32 54
Greece 10 39 51
Netherlands 18 29 50
South Africa 20 30 50
Spain 19 31 49
USA 22 26 48
Canada 18 32 48
NewZealand 20 34 43
Austria 20 36 43
Australia 22 33 42
Brazil 19 36 42
China 7 50 42
Switzerland 19 38 42
Russia 17 40 42
UK 25 33 40
Malaysia 14 45 38
Germany 20 39 38
Italy 13 48 36
Singapore 14 46 35
Thailand 7 57 35
Hong Kong 13 56 29
France 12 61 25
Japan 35 42 15

Survey of sexual behaviours
Vol. 3, No. 2, June 2009 Journal of Family and Reproductive Health

43
Table 5:
Range of sexual activities
Heterosexual
Male Heterosexual
Female Homosexual
Male Homosexual
Female Bisexual
Male Bisexual
Female
Vaginal sex
85% 84% - 77% 86% 94%
Giving anal sex
19% 8% 72% 10% 57% 23%
Receiving anal sex
11% 18% 67% 26% 44% 39%
Giving oral sex
58% 56% 83% 77% 71% 71%
Receiving oral sex
56% 55% 81% 74% 69% 75%
Giving/ receiving a
massage
62% 58% 67% 76% 62% 72%
Sexual fantasies
54% 45% 76% 57% 77% 81%
Looking at erotic
materials
56% 34% 74% 34% 74% 70%
Wearing sexy
underwear
26% 52% 25% 46% 34% 62%
Role play
19% 15% 32% 47% 37% 42%
Bondage/ S & M
8% 5% 12% 28% 24% 23%
Telephone sex
11% 9% 16% 48% 16% 24%

Kevan Wylie

Journal of Family and Reproductive Health Journal Vol.3 No.2 June 2009
44
The range of activities varied significantly by country
and this is shown in table 6.
The countries with the highest incidence of sexual
activities are shown in table 7.
The younger the age and the earlier years within a
relationship led to more adventurous and the highest
incidence of range of activities.
Number of sexual partners
The average number of men and women that
participants reported sexual relationships with in their
lifetime is shown in table 8.
Frequency of sexual activity
Two thirds (67%) of participants described having
sex once a week with people in Greece (89%) and
Brazil (85%) having sex most often. Sex happened
the least for participants in Japan (38%) and Nigeria
and America (57%). 29% of participants were having
sex three or four times a week regardless of whether
Table
Table Table
Table 6
66
6:
::
: Average number of activities
in different countries
Country Average number
of activities
Greece 6
Austria 5.6
Brazil 5.5
Switzerland 5.4
South Africa 5.4
Poland 5.2
Canada 5.1
Italy 5.1
Russia 5
Mexico 5
Spain 4.8
Germany 4.8
France 4.8
Netherlands 4.8
Australia 4.8
New Zealand 4.6
Malaysia 4.5
UK 4.4
China 4.4
Hong Kong 4.4
Thailand 4.3
USA 4.2
Singapore 4.2
India 3.7
Japan 2.6
Nigeria 1.8
Table
Table Table
Table 7
77
7:
::
: Countries with the highest incidence of
sexual activities
Highest incidence of …..
Giving/receiving a massage – Greece/South Africa
(77%)
Giving oral sex – Austria (80%)
Receiving oral sex – Greece (81%)
Sexual fantasies – Switzerland (77%)
Wearing sexy underwear – Poland (53%)
Role play – Malaysia (49%)
Receiving anal sex – Japan (33%)
Giving anal sex – Greece (34%)
Telephone sex – Greece (23%)
Bondage/S&M – Austria (17%)
Table
Table Table
Table 8
88
8:
::
: The average number of men and women
that participants reported to have sexual
relationships
Country Men Women
Austria 17 29
Russia 17 28
Greece 10 28
Brazil 11 27
Australia 10 25
Switzerland 14 24
Canada 10 23
Spain 8 21
Italy 7 19
South Africa 7 18
New Zealand 20 17
Germany 9 17
France 7 17
UK 10 16
Netherland 8 14
Japan 8 14
Mexico 6 14
Hong Kong 4 14
USA 9 13
Poland 5 12
Thailand 2 12
Nigeria 3 9
Malaysia 2 9
Singapore 3 8
India 2 6
China 2 4

Survey of sexual behaviours
Vol. 3, No. 2, June 2009 Journal of Family and Reproductive Health

45
they had children or not. 55% stated they were having
sex as frequently as they would like. The agreement
was highest when in a relationship but not living with
their partner (59%) and for people with children
(57%).
Reasons for not engaging in activities
42% of participants stated that they did not agree
that they were comfortable telling their partner what
they did in bed. Those who used sex toys were more
comfortable telling their partner what they liked
(64% versus 57%) as well as those who engaged in a
greater number of sexual activities (52% for one
activity versus 72% for seven or more activities). The
older people get the less comfortable they are.
Women are less comfortable discussing their
preferences than men. Despite being the most fully
satisfied with their sex life, lesbians are the least
likely to discuss what they enjoy. The longer a
relationship continues the less comfortable they get
and the more committed (such as marriage or
cohabiting) the less comfortable people were. Only a
third of respondents discussed sex with friends it was
greater with the younger age group (50% of the 16-24
year old group versus 21% of the 55 plus) and singles
(56% versus 28% married or cohabiting). Relatively
few steps have been taken by people to improve their
sex lives but the most important factors that would
improve satisfaction were more time, more romance
and more fun (table 9).
Participants expressed interest in engaging in sexual
activities they did not currently participate in across
the various sexual activities asked about.
Discussion
This is the most comprehensive world wide study of
sexual behaviours published to date. The survey was
a development of previous annual surveys by a
multinational manufacturer of condoms and related
products to understand the sexual behaviours and
needs of the general population and potential
customers. By use of a structured questionnaire and
by employment of an independent third party agency
Harris International, more robust data was obtained
than in previous internet surveys.
Whilst people recognised the importance of sexual
well being, substantial satisfaction within
relationships was lacking and there was a large
variance across countries. Many modifiable life style
changes particularly around reduction in stress, better
communication skills, more time together and feeling
less tired were cited as universal factors which were
seen as likely to improve sexual satisfaction. These
suggest that good education and lifestyle changes can
bring about changes in overall sexual satisfaction and
sexual well being. The acceptability and use of
additional products to enable this change is an area
where further research should be undertaken.
Previous attempts to understand well being have
been clouded by a number of problems with
definition. A study by Blanchflower and Oswald (12)
identified that greater income did not buy more sex
nor more sexual partners but sexual activity entered
strongly positively in happiness equations rather than
income. Married people had more sex than those who
were single divorced widowed or separated. The
survey of 1600 US men and women between 1998
Table
Table Table
Table 9
99
9:
::
: Steps to improve sex
Percentage of respondents
Used books/videos 38
Used lubricants 29
Looked for information online 29
Looked for information in magazines 29
Used sex toys 24
Used games/role play 13
Talked to GP/nurse about sexual issues 10
Taken pharmaceutical products to help with erection 5
Seen a therapist/relationship counsellor 4
Used herbal libido enhancers 4
Used delay sprays/creams to prolong erection 4
Used medical libido enhancers 3
None of these 31

Kevan Wylie

Journal of Family and Reproductive Health Journal Vol.3 No.2 June 2009
46
and 2002, found that frequency of sexual
relationships was highly related to general happiness.
For the average American an increase in sexual
activity from once monthly to once a week was the
equivalent to the amount of happiness generated by
an additional annual income of 50,000 US dollars.
Sexual activity had a stronger effect on happiness
ratings for more highly educated people compared to
those with lower educational levels. A clear
association between sexual frequency and satisfaction
and overall quality of life was evident across the age
group with a stronger trend observed in the younger
respondents. The happiness maximising number of
sexual partners in the previous year was calculated to
be one. Being gay or lesbian had no statistical
influence on happiness.
Vilarinho & Nobre (13) report that women who
scored higher on sexual satisfaction also scored
significantly higher on sexual self esteem, pleasure,
functioning and positive emotions during sexual
activity particularly self-assurance, joviality and
serenity. These findings concur with some of those
observed in the SWGS and this strengthens the
argument of the observed link between sexual
satisfaction and overall wellbeing although how
attributable this actually is remains area that merits
further investigation.
Considering dissatisfaction along a spectrum of
sexual concerns, difficulties, disorders and
dysfunctions (SCDDD) (14) it is suggested that a
positive health approach and maximising sexual
satisfaction will prevent progression along the
spectrum to more disabling dysfunctions. The
combined effect on the interpersonal relationship
allows a paradigm that can be developed as depicted
in this diagram:
Sexual well being – what is it?
Attempts to describe sexual well being have been
equally limited by the scope of definition. Recent
attempts by the Department of Health in the UK have
focused entirely on health indicators such as teenage
pregnancies and sexually transmitted infections. We
consider sexual well being further by considering
several factors.
Sexual Satisfaction
In a recent survey of the most common problems
presenting to sexologists in the UK (15) the third
most common problem presenting in women was
sexual dissatisfaction (46%) behind loss or absence
of sexual desire (63%) or emotional or relationship
problems (58%) and more common than difficulties
achieving or absence of orgasm (45%). Sexual
dissatisfaction is hard to define and not a diagnostic
entity.
Sexual satisfaction is also hard to define with a
multitude of factors and meanings being described
for this concept. It is influenced by cultural and
religious factors. There is an expectation of an ability
of sexual function. Sexual satisfaction has been
linked with sexual well being by influencing self-
esteem, self-confidence and quality of life. “It is seen
that sexual satisfaction is not just physical pleasure
nor is it the absence of dissatisfaction or problems.
Rather sexual satisfaction involves the overall feeling
we are left with after considering the positive and
negative aspects or sexual rewards and costs of our
sexual relationships.” (16)
Sexual satisfaction, defined by Santtila et al (17) as
no discrepancy between desired frequency and actual
frequency of sexual behaviours was associated with
relationship satisfaction and sexual satisfaction with
vaginal intercourse. Kissing and petting was
positively associated with relationship satisfaction
whereas higher desire and actual frequency of
masturbation were negatively associated with
relationship satisfaction.
Life stresses & sexual
dysfunction
Effect on the
relationship
Negative spiralling
Sexual pleasure and
satisfaction
Positive benefit

Survey of sexual behaviours
Vol. 3, No. 2, June 2009 Journal of Family and Reproductive Health

47
The GBSS (18) reports the sexual needs and desires
of men and women worldwide. Erectile function and
the effect of ED on aspects of the sexual experience
emerged as the most pressing concerns among male
participants.
The concept of a sex life panorama was first
described by Hurlbert and Apt (19) and helps to
understand sexual satisfaction. They describe a
number of factors including the need to dichotomise
between physiological and psychological etiological
factors to understand a problem (20). There are traits
which contribute to sexual satisfaction including
attitudes towards sex, sexual assertiveness and the
degree of emotional involvement with a partner. The
importance of sexual ideology (21) as well as
ensuring subjective self fulfilment are crucial factors
to consider.
There are further factors which are important when
considering sexual satisfaction. The concept of shame
is a tendency to feel worthless or like a bad person in
response to perceived failure to live up to specific
cultural ideas. Chronic shame over perceived
physical shortcomings as well as anxiety that others
will negatively evaluate their body may lead to
particular distress. Women report appearance
concerns more than men across both sexual and non
sexual contacts although appearance concerns were
positively related to both men and women’s sexual
problems in a recent study reported by Sanchez and
Kiefer (22). Being in a relationship was associated
with less sexual self consciousness and less difficulty
achieving orgasm for both men and women. Body
concerns negatively affect sexual pleasure and
promote sexual problems for both men and women.
Relationships, mental health and boredom
The importance of relationship distress is
emphasised which can increase the probability of the
onset and to prolong the course of mental health
problems and there is a bidirectional and reciprocal
effect of the presence of mental health problems
contributing towards relationship distress (23) There
may be distress in sex reflecting problems within the
relationship (24). A further factor that needs
consideration when looking at sexual satisfaction is
the concept of sexual boredom. This can occur in
both dating couples as well as established couple
relationships.
Sexual Pleasure
In further understanding sexual wellbeing the
concept of sexual pleasure needs consideration.
Humans recognise pleasure and most would agree
that it is associated with positive emotions and
moods. However the concept is somewhat nebulous
which is perhaps not surprising when considering it is
less than clear when and how sexual and other
pleasure fits into models of emotion. Individual
responsibilities as well as age, culture and religion
can contribute to this. A number of concepts require
attention including sexual anhedonia where
individuals are capable in engaging in sexual activity
despite the lack of any positive emotion (or pleasure)
and even in the presence of negative emotion. It has
been argued that sexual activity is related to
perceptions of benefits and gains and that inactivity is
a consequence of losses and costs and not to the
pursuit of pleasure itself. The concept of sexual
exchanges is important since sexual behaviour is
rarely without motive.
Similarly, it has been argued that lack of sexual
pleasure may be aneudemonic and social exchange
theory may contribute towards understanding this. A
goal response model has been proposed which has
integrated a number of previous models in
understanding how sex can bring about pleasure
through goal congruent behaviour and as a
consequence an increase in ego involvement (25).
Positive emotions and pleasure can become
supportive of self esteem with happiness,
enhancement of self esteem with pride and
reinforcement of self esteem with love. Preliminary
findings from a study by Ryff et al (26) reported that
18 women with higher levels of eudemonic well
being (the realisation on ones true potential) had
lower levels of salivary cortisol, pro-inflammatory
cytokines, cardio vascular risk and longer duration of
REM sleep compared to those showing lower levels
eudemonic wellbeing. Aneudemonic wellbeing (more
within the realms of subjective well being with life
satisfaction, presence of positive affect and the
absence of negative affect) had minimal linkage to
biomarker assessments. The authors anticipate that
the protective affects of high levels of wellbeing
could be reflected in longer active life expectance and
disability free life years, if sexual well being is seen
to somehow connect these measures there is a
significant potential for ensuring that sexual
wellbeing and general wellbeing are maximised.

Kevan Wylie

Journal of Family and Reproductive Health Journal Vol.3 No.2 June 2009
48
Love
The concept of love, pleasure and lust as a stress
reducing and health promoting potential is a further
concept which we believe important for
consideration. Love and pleasure ensures the survival
of individuals and the species and encompasses
wellness and feeling of wellness across a number of
spectrums.
Intimacy
A number of factors including shame, envy, self
consciousness, trust, attachment, self esteem, culture
and religion can all effect sexual intimacy. The
intimacy based model of the female sexual response
cycle as proposed by Basson (27) assumes a stance of
initial sexual neutrality. Emotional and physical
satisfaction occurs when there is expectation of
emotional intimacy.
How we link this to sexual desire and sexual well
being and sexual health is challenging. Importantly
we must differentiate between low sexual interest
(17-55% of all women according to a recent review
by Lewis et al (28)) and low sexual desire. The
concept of HSDD with actual distress and the recent
refinement of the definition by Basson et al (29) with
the AFUD consultation attempts to differentiate this
group. Despite this a recent substantial survey by
Schneidewind-Skibbe et al (30) found that of all the
factors associated with the frequency of sexual
activity in women, sexual desire (3) and satisfaction
with sex life (2) were found to have a significant
association with only a small number when compared
to other factors such as pregnancy and the age of the
women.
Conclusion
The findings of the sexual wellbeing global survey
show a rich diversity and difference between groups,
countries and cultures. A number of reasons to
account for this have been considered. A number of
factors can affect sexual satisfaction and sexual
intimacy including shame, envy, self consciousness,
trust, love, and attachment, motivation for pleasure
and self esteem particularly within minority ethnic
and culture groups.
One of the roles of sex therapists and sexual
medicine physicians is to enhance the opportunity
and experience of intimacy within both the individual
with self satisfaction as well as within relationships.
The interplay of sexual well being and sexual
satisfaction and maintaining levels of sexual desire
that are favourable for both partners must be a stated
and agreed goal. Clinical attention to issues that
assure sexual satisfaction and sexual wellbeing can
have considerable influence on overall sexual desire
and so general well being.
Acknowledgment:
This study was funded by SSL/Durex.
References
Laumann EO, Gagnon JH, Michael RT, Michaels S. The
social organization of sexuality: sexual practices in the
United States, University of Chicago Press, Chicago 1994.
Atkins DC, Dimidjian S, Jacobson NS. Why do people have
affairs? Recent research and future directions about
attributions for extramarital involvement. In Manusov VL
& Harvey HJH. (Eds) Attribution, communication
behaviour, and close relationships. Cambridge University
Press. 2001: 305-19.
Allen EB, Atkins DC, Baucom DH, Snyder DK, Gordon
KC, Glass SP. Intrapersonal, interpersonal, and contextual
factors in engaging in and responding to infidelity.
Clinical Psychology: Science and Practice 2005;12: 101—
30.
Coleman E. Promoting sexual health and responsible sexual
behaviour. Journal of Sex Research 2002; 39: 3-6.
Dunn KM, Croft PR, Hackett GI. Satisfaction in the sex life
of a general population sample. Journal of sex and marital
therapy 2000; 26 :141-51.
Bancroft J, Janssen E, Strong D, Carnes L, Vukadinovic Z,
Long JS. Sexual risk-taking in gay men: the relevance of
sexual arousability, mood, and sensation seeking.
Archives of sexual behaviour 2003; 32:555-72.
Laumann EO, Paik A, Glasser DB, Kang JH, Wang T,
Levinson B, et al. A cross-national study of subjective
well being among older men and women: findings from
the global study of sexual attitudes and behaviours.
Archieves of Sexual Behaviour 2006; 35:145- 61.
DeLamater J, Moorman SM. Sexual Behavior in Later Life.
Journal of Aging and Health 2004; 6: 921- 45.
Burgess E .Sexuality in midlife and later life couples. In
Harvey J.H., Wenzel A & Sprecher S (Eds) The
Handbook of Sexuality in Close Relationships. Routledge
2004.
Lindau ST, Schumm LP, Laumann EO, Levinson W,
O'Muircheartaigh CA, Waite LJ. A study of sexuality and
health among older adults in the United States. New
England Journal of Medicine 2007; 357:762-74.
Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C,
Moreira E, et al. GSSAB Investigators' Group. Sexual
problems among women and men aged 40-80 y:
prevalence and correlates identified in the Global Study of
Sexual Attitudes and Behaviours. International Journal of
Impotence Research 2005; 17:39-57.
Blanchflower DG, Oswald AJ. Money, Sex and Happiness:
An Empirical Study Scandinavian Journal of Economics
2004; 106 : 393–415.

Survey of sexual behaviours
Vol. 3, No. 2, June 2009 Journal of Family and Reproductive Health

49
Vilarinho S, Nobre P. Portuguese women's sexuality and
biopsychossocial determinants: a focus on sexual well-
being. Sexologies 2008; 17: S149.
Wylie KR. Assessment and management of sexual
problems in women. J R Soc Med 2007; 100: 547-50.
Wylie KR, DeColomby P, Giami A. Sexology as a
profession in the United Kingdom. International Journal
of Clinical Practice 2004; 58:764-8.
Macneil S, Byers S. The Relationships between Sexual
Problems, Communication and Sexual Satisfaction. The
Canadian Journal of Human Sexuality 1997; 6: 277- 83.
Santtila P, Wager I, Witting K, Harlaar N, Jern P,
Johansson A, et al. Discrepancies between sexual desire
and sexual activity: gender differences and associations
with relationship satisfaction. J Sex Marital Ther 2008;
34: 29-42.
Mulhall J, King R, Glina S, Hvidsten K. Importance of and
satisfaction with sex among men and women worldwide:
Results of the Global Better Sex Survey. J Sex Med 2008;
5:788– 95.
Hulbert DR, Apt C. Female sexual desire, response, and
behavior. Behavior Modification 1994; 18: 488-504.
Davison JK, Darling CA. Self-perceived differences in the
female orgasmic response. Family Practice Res J 1989;
8:75-84.
Rosenzweig JM, Dailey DM. Dyadic adjustment/sexual
satisfaction in women and men as a function of
psychological sex role self-perception. Journal of Sex and
Marital Therapy 1989; 15:42-56.
Sanchez DT, Kiefer AK. Body concerns in and out of the
bedroom: implications for sexual pleasure and problems.
Archives of Sexual Behaviour 2007; 36: 808-20.
Snyder DK, Whisman MA. Treating distressed couples
with coexisting mental and physical disorders; directions
for clinical training and practice. Journal of Martial and
Family Therapy 2004; 30: 1-12.
Baldwin JD, Baldwin JI. Gender differences in sexual
interest. Achieves of Sexual Behaviour 1997; 26: 181-210.
Boul L, Hallam-Jones R, Wylie KR. Sexual Pleasure And
Motivation. Journal of Sex and Marital Therapy 2009; 35:
25-39.
Ryff CD, Dienberg Love G, Urry HL, Muller D,
Rosenkranz MA, Friedman EM, et al. Psychological well-
being and ill-being: do they have distinct or mirrored
biological correlates? Psychotherapy Psychosomatic 2006;
75: 85-95.
Basson R. Female sexual response: the role of drugs in the
management of sexual dysfunction. Journal of Obstetrics
and Gynaecology 2001; 98: 350-3.
Lewis RW, Fugl-Meyer KS, Bosch R, Fugl-Meyer AR,
Laumann EO, Lizza E, et al. Epidemiology/Risk Factors
of Sexual Dysfunction.
The Journal of Sexual Medicine 2004; 1: 35–9.
Basson R, Leiblum S, Brotto L, Derogatis L, Fourcroy J,
Fugl-Meyer K, et al. Revised definitions of women’s
sexual dysfunction. Journal of Sexual Medicine 2004; 1:
40- 8.
Schneidewind-Skibbe A, Hayes RD, Koochaki PE, Meyer
J, Dennerstein L. The frequency of sexual intercourse
reported by women: a review of community-based studies
and factors limiting their conclusions. Journal of Sexual
Medicine 2008; 5: 301-35.