Characteristics of heterosexual regular relationships among a representative sample of adults: the Second Australian Study of Health and Relationships

Navigating Conflicting Ideals of Masculinity: A Qualitative Study of the Experiences of Male Partners of Women with Vulvodynia

Vulvodynia, a long-term genital pain disorder with a high lifetime prevalence, profoundly impacts both the affected women and their partners. However, the experiences of these partners have been under-researched. Using Braun and Clarke's thematic analysis, this qualitative study explored the experiences of male partners of women with vulvodynia. In individual interviews with seven men (20-32 years), four themes were identified: "Trying to be a good and caring partner," "Fear of sexual and emotional rejection," "Feelings of insecurity and being misled," and "Keeping up the façade." Despite efforts to support their partners, the men often faced rejection, leading to insecurities about their attractiveness, the relationship's future, and their ability to conform to social expectations. They coped by concealing insecurities from their partners and overemphasizing traditional masculinity among peers. We discuss these results using sexual script theory, suggesting that gendered sexual scripts play a significant role in relationships with vulvodynia, with prevailing cultural assumptions regarding masculinity challenging men's ability to be simultaneously caring and sexual. As a result, the men found themselves negotiating two contrasting ideals associated with masculine behavior: those of good caregiver and assertive, virile sexual partner. Our research suggests that male partners of women with vulvodynia tend to be left alone to deal with the resulting ambivalence and distress. Supporting these men could benefit both parties in managing vulvodynia.

A Narrative Review of the Dichotomy Between the Social Views of Non-Monogamy and the Experiences of Consensual Non-Monogamous People

Monogamy is deeply rooted in most Western societies, shaping how people construe and behave in romantic relationships. These normative views facilitate the emergence of negative perceptions and evaluations when people choose not to adhere to mononormativity. Even though people in consensual non-monogamous (CNM) relationships are targets of stigmatization, research shows a dichotomy between these negative views and the relational experiences of CNM people. Indeed, people in CNM and monogamous relationships have comparable relationship functioning and quality and struggle with similar relationship problems. One of the differences is that CNM relationships afford people to explore their sexuality and fulfill their needs with multiple partners, without agreed-upon extradyadic behavior being perceived as infidelity or having deleterious consequences to relationship maintenance. These positive experiences notwithstanding, CNM people are continuously pressured by mononormativity and stigmatization, increasing the risk of internalized CNM negativity and worse personal and relational outcomes. One possible way to counteract CNM stigmatization and improve the lives of CNM people is by changing discourses surrounding non-monogamy and improving acceptance, not only in professional settings but also in the general population. Another strategy is to understand how the relationship beliefs and scripts of younger generations can help promote more inclusive and diverse societies.

Sexual activity in a large representative cohort of Polish men: Frequency, number of partners, correlates, and quality of life

INTRODUCTION

Sexual activity of men has been evaluated at the population-level in different regions of the world. However, reliable data are lacking for Eastern Europe. Therefore, the aim of this study was to analyze the frequency of sexual activity and the number of sexual partners in a large representative cohort of Polish men.

METHODS

We performed a cross-sectional investigation with computer-assisted web interviews. Participants were stratified by age (≥18 years) and place of residence. The most recent population census was used to produce a population-representative sample of respondents. Men's sexual activity was then correlated with multiple variables.

RESULTS

We enrolled 3001 men, representative for age and place of residence, including adequate proportions of respondents from urban and rural areas. Most Polish men were sexually active, predominantly having had sex at least weekly with one partner. Almost 18% of respondents declined sexual intercourse and/or sexual partner in the prior year. The highest sexual activity was observed for men 35-44-years-old (for sex frequency) and 18-24-years-old (for partner number), living in medium-sized cities, employed, and married (for sex frequency) or divorced (for partner number). Erectile dysfunction negatively affected the frequency of sexual activity and lowered the number of sexual partners, although premature ejaculation did not have any effect. Frequency of sexual activity and number of sexual partners correlated well with psychological distress, quality of sex life, and overall life quality. Whereas lifestyle habits including smoking and alcohol intake decreased the likelihood of sexual activity, all analyzed comorbidities did not affect sex life.

CONCLUSIONS

This study of men's sexual activity was the first population-representative and nationwide investigation performed in Poland. Most Polish men were sexually active and sexual activity correlated with multiple variables including sociodemographic factors, erectile functioning, mental distress, overall and sex-specific quality of life, and lifestyle habits.

The Relation of Sexual Attitudes to Hypersexuality and Problematic Pornography Use

Previous studies have shown that specific attitudes related to moral convictions can have an important role in the development and maintenance of problematic sexual behavior symptoms. However, although other types of attitudes, like sexual attitudes, are potentially highly relevant, they have not yet been studied in this role. We investigated how four dimensions of sexual attitudes: Permissiveness, Birth Control, Communion and Instrumentality, contribute to problematic pornography use (PPU) and hypersexual disorder (HD) symptoms, controlling for religiosity, sex, age and relationship status. The study was administered through an online questionnaire and based on a representative sample of n = 1036 (M_age = 43.28, SD = 14.21; 50.3% women) Polish adult citizens. When adjusting for other variables, higher sexual Permissiveness positively predicted HD and PPU among both men (HD: β = .26, p < .001; PPU: β = .22, p < .001) and women (HD: β = .44, p < .001; PPU: β = .26; p < .001). Sexual Instrumentality positively, although weakly, contributed to HD severity among men (β = .11, p < .05). Attitudes reflecting higher support for responsible sexuality (Birth Control subscale) negatively and weakly predicted HD among women (β = - .11, p < .05). Permissiveness was also the only sexual attitude dimension that consistently predicted a higher frequency of sexual activity among men and women. Based on the cutoff criteria proposed by the authors of the used screening instruments (≥ 53 points for the Hypersexual Behavior Inventory and ≥ 4 points for the Brief Pornography Screen), the prevalence of being at risk for HD was 10.0% (men: 11.4%, women: 8.7%) and for PPU was 17.8% (men: 26.8%, women: 9.1%). Our results point to a significant contribution of sexual attitudes to problematic sexual behavior symptoms, which was not encapsulated by the previously studied influence of religious beliefs, although most of the obtained relationships were relatively weak. Particularly, a consistent link between permissive attitudes and both HD and PPU among men and women may indicate that permissive attitudes can potentially contribute to the development and maintenance of problematic sexual behavior. The prevalence of being at risk for PPU (and to some degree HD) in the current representative sample was high. Such results raise questions about the appropriateness of the proposed cutoff criteria and the risk of overpathologizing normative sexual activity, if the cutoff thresholds are not tailored adequately. The results have implications for the assessment, diagnosis and theory of problematic sexual behavior.

Sexual Difficulties, Problems, and Help-Seeking in a National Representative Sample: The Second Australian Study of Health and Relationships

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 years (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.

Trends and Correlates of Age-Disparate Sexual Partnerships in the United States: The National Health and Nutrition Examination Surveys

ABSTRACT

This national survey demonstrates age-disparate (≥5 years; AD-5) sexual partnerships remain common among males and females aged 20 to 29 years in the United States (2005-2016). Females reported more older AD-5 partners, and males reported more younger AD-5 partners. Having AD-5 partners was associated with greater lifetime and recent number of sexual partners.

Study of Sexual Satisfaction in Different Typologies of Adherence to the Sexual Double Standard

The sexual double standard (SDS) refers to the acceptance of different criteria to assess the same sexual behavior in men and women. To date, the few studies that have addressed the relationship between SDS and sexual satisfaction have obtained inconclusive results. In addition, no study has analyzed sexual satisfaction in people who maintain different forms of adherence to the SDS. This study establishes three SDS typologies of adherence (man-favorable, woman-favorable, egalitarian) in two areas of sexual behavior (sexual freedom and sexual shyness) to examine the predictive capacity of personal variables (age, social dominance orientation, propensity for sexual excitation/inhibition), interpersonal variables (relationship satisfaction) and social variables (gender norms about sexual behaviors) in sexual satisfaction. A sample of 1194 heterosexual adults (51.1% men, 48.8% women) aged between 18 and 87 years (M = 40.63; SD = 15.67), who had been in a relationship for more than 6 months, was evaluated. In men, the highest sexual satisfaction levels were obtained in the egalitarian typology in the sexual freedom area. In women, no significant differences were found between the typologies of adherence to the SDS. Regression models showed that relationship satisfaction was the main predictor of sexual satisfaction in all the typologies in both men and women. In addition, the predictive relationship of personal variables with sexual satisfaction varied according to gender and the SDS adherence type. The results show the importance of studying sexual satisfaction by taking into account not only the differences between men and women. Furthermore, it is essential to consider other differences between people; for example, the difference that derives from the way of psychologically internalizing attitude toward the SDS.

Romantic Jealousy: A Test of Social Cognitive and Evolutionary Models in A Population-Representative Sample of Adults

Whereas sexually dimorphic evolutionary models argue for clear sex differences in responses to jealousy-evoking scenarios, social cognitive models emphasize the importance of other factors. This paper explores variables associated with responses to a commonly-used jealousy-evoking scenario in a population-representative sample. Data from 8,386 Australian men and women aged 16-69 were weighted to match the population. The results provided some support for evolutionary models among heterosexual respondents, but findings contrary to evolutionary models were found among non-heterosexual respondents. Support for social cognitive models was provided by the identification of six variables that had significant independent multivariate associations with jealousy: sex, age, education, lifetime number of partners, relationship status, and attitudes toward infidelity. The results suggest that although men and women may tend to respond differently to sexual or emotional infidelity scenarios, the anticipated experience of jealousy in each context is strongly influenced by biographical and cultural factors.

Experiences of Bisexual Identity, Attraction, and Behavior and Their Relationship With Mental Health Findings From the Who I Am Study

Approximately one in 10 Australian individuals report bisexual attraction, and this group has repeatedly been found to experience high rates of poor mental health. Despite this finding, our understanding of who is most at risk within this group remains limited. The current article presents findings of an online survey conducted in Australia with one of the largest samples of bisexual adults to date (N = 2,651). Chi-square and regression analyses identified significant associations between the three dimensions of bisexuality (i.e., identity, behavior, and attraction) and mental health. Participants who reported identifying as bisexual were found to be especially vulnerable to poor mental health compared to those who reported bisexual attraction and/or sexual experiences without a bisexual identity. These findings provide a significant contribution to the lacking literature on the complexities of bisexual orientation and mental health. [Journal of Psychosocial Nursing and Mental Health Services, 58(3), 28-37.].

Sexual mixing in opposite-sex partnerships in Britain and its implications for STI risk: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Background

The extent to which individuals are similar to their sexual partners influences STI-transmission probabilities, yet there is a dearth of empirical data, especially those representative of the population.

Methods

Analyses of data reported by 10 759 sexually active people aged 16–74 y interviewed for a British national probability survey undertaken in 2010–12. Computer-assisted self-interviews asked about partner numbers and characteristics of participants’ three most recent partnerships (MRPs). Opposite-sex MRPs were weighted to represent all such partnerships in the past year (N = 16 451). Estimates of disassortative age mixing (≥±5-y difference), ethnic mixing (partner of a different ethnic group) and geographical mixing (partner from a different region/country when they first met) were calculated, stratified by gender, age group and partnership status (casual/steady). Multivariable regression examined how these disassortative mixing measures were associated with STI-risk measures: condom use at first sex together at the partnership-level and, at the participant-level, STI-risk perception and reporting STI diagnoses.

Results

Disassortative age mixing occurred in around one-third of opposite-sex partnerships, with men ≥5 y older in most cases, although this proportion varied by participant’s gender and age group. Ethnic mixing occurred less frequently (11.3% of men’s and 8.6% of women’s partnerships) as did geographical mixing (14.1 and 16.3%, respectively). Disassortative mixing was more common among casual vs steady partnerships. Condom use at first sex was less likely in women’s partnerships that were age-disassortative [adjusted odds ratio (AOR): 0.79, 95% confidence interval (CI): 0.69–0.95], whereas men reporting disassortative ethnic mixing were more likely to perceive themselves at STI risk (AOR: 1.76, 95% CI: 1.23–2.52) and report STI diagnoses (AOR: 2.37, 95% CI: 1.22–4.59).

Conclusions

Disassortative mixing, although uncommon among opposite-sex partnerships in Britain, is independently associated with STI risk, warranting consideration in STI-prevention efforts.

Age differences in attitudes toward safer sex practices in heterosexual men using an Australian Internet dating service

Background This cross-sectional study investigated sexually transmissible infection (STI) knowledge, safer sex attitudes and behaviours of sexually active, heterosexual men using an Internet dating service, and explored factors associated with protective attitudes.

METHODS

An anonymous online survey was sent to men who had logged onto an Internet dating service within the previous year. Factors associated with discussing STIs before sex and condom use intention with a new partner were analysed.

RESULTS

In total, 2339 responses were analysed. Men had lower STI knowledge scores, lower use of condoms and greater beliefs that condoms reduced interest in sex as age increased. Younger men (aged 18-29 years) were more likely to report intentions of only having sex with a new partner if a condom was used compared with older men aged over 60 years. Predictors of having a discussion about STIs with a new partner were older age, better knowledge of STIs, greater distress at a potential diagnosis of an STI and stronger future condom use intention. Intention to only have sex with a new female partner if a condom was used was associated with higher STI knowledge, discussing STIs with a new partner and distress at a diagnosis of an STI. Men with a higher number of sexual partners in the last year were less likely to have an STI discussion with new partners or intend to use a condom with a new partner.

CONCLUSIONS

Older Internet-dating, heterosexual men are vulnerable to STIs. Health promotion interventions to increase STI awareness, condom use and STI testing in older men are warranted.

Sexual practices and risk behaviors of Israeli adult heterosexual men

The knowledge of sexual practices of heterosexual males (HM) in Israel is limited despite the increase inthe incidence of sexually transmitted diseases (STI). This study assessed sexual practices among Israeli HM and the associations between demographic characteristics and sexual risk behaviors. The Cross-sectional study included a representative sample of 913 Jewish HM aged 18-44, which completed a questionnaire including their demographics, sexual practices, and risky sexual behavior. Of all participants, 66.8% had monogamous sex with their steady partner. These participants were more likely to be older, religious, involved ina limited repertoire of sexual practices, and less likely to engage in risky sexual behavior. Of the participants, 9.6% were in steady relationships but had concomitant sexual casual partner/s. They were more likely to be secular, paid for sex, and had more lifetime sexual partners. Of all the participants, 23.6% were singles and had sex with casual partner/s. They were more likely to be younger and engage in risky sexual behavior. Of all participants, 10.3% were involved in risky sexual behavior. These men were more likely to be singles, pay for sex and have more lifetime sexual partners. We conclude that preventive interventions aimed to prevent STI-infections should target HM who are in singles and those in steady relationships and have concomitant sex partners.

Simultaneously characterizing the comparative economics of routine female adolescent nonavalent human papillomavirus (HPV) vaccination and assortativity of sexual mixing in Hong Kong Chinese: a modeling analysis

BACKGROUND

Although routine vaccination of females before sexual debut against human papillomavirus (HPV) has been found to be cost-effective around the world, its cost-benefit has rarely been examined. We evaluate both the cost-effectiveness and cost-benefit of routine female adolescent nonavalent HPV vaccination in Hong Kong to guide its policy, and by extension that of mainland China, on HPV vaccination. One major obstacle is the lack of data on assortativity of sexual mixing. Such difficulty could be overcome by inferring sexual mixing parameters from HPV epidemiologic data.

METHODS

We use an age-structured transmission model coupled with stochastic individual-based simulations to estimate the health and economic impact of routine nonavalent HPV vaccination for girls at age 12 on cervical cancer burden and consider vaccine uptake at 25%, 50%, and 75% with at least 20 years of vaccine protection. Bayesian inference was employed to parameterize the model using local data on HPV prevalence and cervical cancer incidence. We use the human capital approach in the cost-benefit analysis (CBA) and GDP per capita as the indicative willingness-to-pay threshold in the cost-effectiveness analysis (CEA). Finally, we estimate the threshold vaccine cost (TVC), which is the maximum cost for fully vaccinating one girl at which routine female adolescent nonavalent HPV vaccination is cost-beneficial or cost-effective.

RESULTS

As vaccine uptake increased, TVC decreased (i.e., economically more stringent) in the CBA but increased in the CEA. When vaccine uptake was 75% and the vaccine provided only 20 years of protection, the TVC was US$444 ($373-506) and $689 ($646-734) in the CBA and CEA, respectively, increasing by approximately 2-4% if vaccine protection was assumed lifelong. TVC is likely to be far higher when non-cervical diseases are included. The inferred sexual mixing parameters suggest that sexual mixing in Hong Kong is highly assortative by both age and sexual activity level.

CONCLUSIONS

Routine HPV vaccination of 12-year-old females is highly likely to be cost-beneficial and cost-effective in Hong Kong. Inference of sexual mixing parameters from epidemiologic data of prevalent sexually transmitted diseases (i.e., HPV, chlamydia, etc.) is a potentially fruitful but largely untapped methodology for understanding sexual behaviors in the population.

Sexual Satisfaction Among Older Australian Heterosexual Men and Women: Findings from the Sex, Age & Me Study

This study explored sexual satisfaction in older heterosexual Australians using data from a national sample of 1,583 men and women aged 60+ who hoped or planned to have sex in the future. Data collection took place in 2015; participants were recruited using a variety of online and offline advertisements. Less than half the sample (46%) reported they were very or extremely satisfied with their sexual lives. Those who had sex more often and were more interested in sex were more likely to be satisfied, while those who wanted sex more often in the future were less likely to be satisfied, as were men who had experienced sexual difficulties. Sexual satisfaction was also associated with life satisfaction in men and positive mental health in women. Factors associated with satisfaction in this study will help guide strategies to support older people in realizing the sexual lives they desire.

Bisexual Mental Health: A Call to Action

Over the past two decades research has consistently found that bisexual people experience poorer mental health than their gay, lesbian or heterosexual counterparts. The reasons behind this high prevalence of poor mental health remain under-researched and largely unknown. In order to improve these outcomes, more research is critically needed with the aim of providing new knowledge upon which health care provision and policy development can be based. This article presents an analysis of the literature to date relating to bisexuality broadly and bisexual mental health specifically, with the aim of providing direction for future research projects.

Performing (heterosexual) femininity: female agency and role in sexual life and contraceptive use - a qualitative study in Australia

Women's liberation and the sexual revolution have changed the social landscape for heterosexual women in the West over the past 50 years, but exploration of women's lived experiences of contraceptive use in the context of their sexual lives is comparatively recent. We conducted 94 in-depth open-ended interviews with women of reproductive age (16-49 years) living in New South Wales, Australia. Interviews were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach. Four major themes are explored here: (1) what women do and do not do: unspoken gendered assumptions; (2) focus on partner's pleasure; (3) juggling responsibilities: sex as a chore; and (4) women's sexual motivations. Findings suggest sexual double standards and gender expectations continue to pervade women's sexual and contraceptive practices. We found that women performed their femininity by focusing on enabling their male partner's pleasure, while simultaneously ignoring their own sexual desires, wishes or interests. Accompanying new-found freedoms are new-found responsibilities, as women now add managing modern contraceptives and a good sex life to their list of tasks alongside paid employment, domestic labour and childrearing. Our research findings suggest that women may derive different pleasures from sex, including what we term 'connection pleasure'.

A Profile of Pornography Users in Australia: Findings From the Second Australian Study of Health and Relationships

There are societal concerns that looking at pornography has adverse consequences among those exposed. However, looking at sexually explicit material could have educative and relationship benefits. This article identifies factors associated with looking at pornography ever or within the past 12 months for men and women in Australia, and the extent to which reporting an "addiction" to pornography is associated with reported bad effects. Data from the Second Australian Study of Health and Relationships (ASHR2) were used: computer-assisted telephone interviews (CASIs) completed by a representative sample of 9,963 men and 10,131 women aged 16 to 69 years from all Australian states and territories, with an overall participation rate of 66%. Most men (84%) and half of the women (54%) had ever looked at pornographic material. Three-quarters of these men (76%) and more than one-third of these women (41%) had looked at pornographic material in the past year. Very few respondents reported that they were addicted to pornography (men 4%, women 1%), and of those who said they were addicted about half also reported that using pornography had had a bad effect on them. Looking at pornographic material appears to be reasonably common in Australia, with adverse effects reported by a small minority.

The Sexual Acceptability of Contraception: Reviewing the Literature and Building a New Concept

How contraceptives affect women's sexual well-being is critically understudied. Fortunately, a growing literature focuses on sexual aspects of contraception, especially hormonal contraception's associations with libido. However, a more holistic approach to contraceptive sexual acceptability is needed to capture the full range of women's sexual experiences. We conducted a narrative literature review of this topic, working with an original sample of 3,001 citations published from 2005 to 2015. In Part 1, we draw from a subset of this literature (264 citations) to build a new conceptual model of sexual acceptability. Aspects include macro factors (gender, social inequality, culture, and structure), relationship factors (dyadic influences and partner preferences), and individual factors (sexual functioning, sexual preferences, such as dis/inhibition, spontaneity, pleasure, the sexual aspects of side effects, such as bleeding, mood changes, sexual identity and sexual minority status, and pregnancy intentions). In Part 2, we review the empirical literature on the sexual acceptability of individual methods (103 citations), applying the model as much as possible. Results suggest contraceptives can affect women's sexuality in a wide variety of positive and negative ways that extend beyond sexual functioning alone. More attention to sexual acceptability could promote both women's sexual well-being and more widespread, user-friendly contraceptive practices.

Transitioning from cytology-based screening to HPV-based screening at longer intervals: implications for resource use

Background

Following a recent major review of cervical screening, from 2017 Australia will transition from two-yearly cytology-based screening to five-yearly primary HPV screening, with partial genotyping and direct referral for HPV 16/18 and LBC triage for other oncogenic types. Switching to a longer screening interval will result in transitional fluctuations for volumes of tests before a 'steady state' is reached for the new test volumes. This study aimed to quantify the impact of this transition on year-to-year volumes of screening and follow-up tests and procedures.

Methods

Number of women screened and test volumes from 2015 to 2032 were estimated via a detailed simulation model which explicitly modelled varying screening and HPV vaccination exposure in individual birth cohorts, and fully incorporated how a relatively rapid screening program switch in 2017 would affect both women attending for routine screening and those in surveillance following an abnormality.

Results

Numbers of women screened and HPV tests are predicted to fluctuate in the first screening rounds as a result of the transition to a longer screening interval (mean women screened and HPV tests 1.4 million in the first 5-year period, year-to-year fluctuation > +/−50 %; mean 1.5 million women/HPV tests in third 5-year period, fluctuation approximately +/−25 %). The extent to which this fluctuation was predicted to carry through to secondary tests/procedures was less (fluctuations of +25 %/-31 % in first 5-year period; decreasing to +8 %/-10 % by third round). HPV vaccination is predicted to counteract increases in high grade cytology results, colposcopies and precancer treatments which would otherwise occur due to population increases. Precancer treatments are predicted to drop below 2015 levels within the first few years of program switchover. Mean colposcopy volumes are predicted to be similar to 2015 levels by the third round of HPV-based screening, and also be 25–40 % lower than would have occurred in the absence of HPV vaccination.

Conclusions

While numbers of women attending for screening and HPV tests are anticipated to initially fluctuate as a result of the transition to a longer recommended interval, there is expected to be less fluctuation in follow-up tests and procedures; however these will still have a significant impact on operational aspects of the screening program. Detailed modelling of the switchover process gave important insights into how volumes would be affected.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1375-9) contains supplementary material, which is available to authorized users.

Comparison of age-specific patterns of sexual behaviour and anal HPV prevalence in homosexual men with patterns in women

OBJECTIVES

Anal human papillomavirus (HPV) is highly prevalent in men who have sex with men (MSM) of all ages, whereas cervical HPV declines with age. We explore the hypothesis that different sexual behavioural patterns are the basis of this difference in age distribution.

METHODS

Published data on age-specific HPV prevalence for women (cervical HPV) were extracted from a large meta-analysis and for MSM (anal HPV) from the EXPLORE study of HIV-negative MSM. Age-specific data on recent sexual activity were extracted from two behavioural surveys: the second Australian Study of Health and Relationships survey and the 2013 Gay Community Periodic Survey.

RESULTS

At least 50% of MSM at all ages reported more than one sexual partner in the past 6 months. In comparison, 33% of women aged 16-19 years reported more than one partner over the past year. This decreased to 19% and 6% in women aged 20-29 and 30-39 years, respectively, and to fewer than 5% of women in older age groups. Prevalent anal HPV was detected in over 50% of MSM in each age group. Prevalence did not decline with age. In contrast, there was a steady decrease in cervical HPV prevalence with age. Cervical HPV prevalence fell from 23% among North American women aged <25 years to 3% in women aged ≥65 years.

CONCLUSIONS

In contrast to the decreasing prevalence with age among heterosexual women, the high prevalence and lack of decline in prevalent anal HPV among older MSM are likely to be related to continuing high rates of newly acquired HPV infection from ongoing sexual exposure through new partners.

Perceived causes and consequences of sexual changes after cancer for women and men: a mixed method study

BACKGROUND

Previous research on cancer and sexuality has focused on physical aspects of sexual dysfunction, neglecting the subjective meaning and consequences of sexual changes. This has led to calls for research on cancer and sexuality to adopt an "integrative" approach, and to examine the ways in which individuals interpret sexual changes, and the subjective consequences of sexual changes.

METHOD

This study examined the nature and subjective experience and consequences of changes to sexual well-being after cancer, using a combination of quantitative and qualitative analysis. Six hundred and fifty seven people with cancer (535 women, 122 men), across a range of reproductive and non-reproductive cancer types completed a survey and 44 (23 women, 21 men) took part in an in-depth interview.

RESULTS

Sexual frequency, sexual satisfaction and engagement in a range of penetrative and non-penetrative sexual activities were reported to have reduced after cancer, for both women and men, across reproductive and non-reproductive cancer types. Perceived causes of such changes were physical consequences of cancer treatment, psychological factors, body image concerns and relationship factors. Sex specific difficulties (vaginal dryness and erectile dysfunction) were the most commonly reported explanation for both women and men, followed by tiredness and feeling unattractive for women, and surgery and getting older for men. Psychological and relationship factors were also identified as consequence of changes to sexuality. This included disappointment at loss of sexual intimacy, frustration and anger, sadness, feelings of inadequacy and changes to sense of masculinity of femininity, as well as increased confidence and self-comfort; and relationship strain, relationship ending and difficulties forming a new relationship. Conversely, a number of participants reported increased confidence, re-prioritisation of sex, sexual re-negotiation, as well as a strengthened relationship, after cancer.

CONCLUSION

The findings of this study confirm the importance of health professionals and support workers acknowledging sexual changes when providing health information and developing supportive interventions, across the whole spectrum of cancer care. Psychological interventions aimed at reducing distress and improving quality of life after cancer should include a component on sexual well-being, and sexual interventions should incorporate components on psychological and relational functioning.

Change and stasis in sexual health and relationships: comparisons between the First and Second Australian Studies of Health and Relationships

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Design and methods of the Second Australian Study of Health and Relationships

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.

Safer sex and condom use: findings from the Second Australian Study of Health and Relationships

Background It is important to have current and reliable estimates of the frequency and correlates of condom use among Australian adults. Methods: A representative sample of 20 094 men and women aged 16–69 years, from all states and territories, completed computer-assisted telephone interviews. The overall participation rate among eligible people was 66.2%. Results: Although most respondents had used a condom at some time in their lives, fewer than half of those who were sexually active in the year before being interviewed had used a condom in that year. Condom use in the last year was associated with youth, speaking a language other than English at home, bisexual identity, greater education, residence in major cities, lower income and having multiple sexual partners in the last year. One-quarter of respondents used a condom the last time they had vaginal intercourse and one-sixth of these were put on after genital contact. Condom use during most recent vaginal sex was associated with youth, lower income, having sex with a non-regular partner and not using another form of contraception. Condom use appears to have increased between 2001–02 and 2012–13. Conclusion: Consistent with other research, this study showed that condom use was strongly associated with partner type and use of other contraception. There may be a need to highlight among people with multiple sexual partners the fact that non-barrier methods of contraception do not offer protection against sexually transmissible infections. The finding that many condoms were applied after genital contact suggests a need to promote both use and correct use of condoms.