The Natsal-SF: a validated measure of sexual function for use in community surveys.

Sexual dysfunction often features as an outcome variable in community health surveys and epidemiological surveys. Key design imperatives for measures included in large scale, population-based surveys are acceptability, brevity and relevance to diverse sexual lifestyles. None of the available measures of sexual dysfunction are entirely suited to this task. We developed a new measure of sexual function for the third British National Survey of Sexual Attitudes and Lifestyles (Natsal 3). Items for the measure were derived from qualitative work from patients and community members. The draft measure was developed and validated using a general population sample (internet panel survey (n = 1,262)) and a clinical sample (patients attending sexual problems clinics (n = 100). Confirmatory factor analysis established that a 'general-specific model' had the best fit and was equivalent between general population and clinical samples (Comparative Fit Index = 0.963 Tucker Lewis Index = 0.951; Root Mean Square Error of Approximation = 0.064). The 17-item Natsal-SF is positively associated with the Female Sexual Function Index-6 (B = 0.572) and Brief Sexual Function Questionnaire for men (B = 0.705); it can discriminate between clinical and general population groups (OR = 2.667); and it has good test-retest reliability (r = 0.72). The Natsal-SF provides an estimate of the level of sexual function in the last year. By including items on distress about sex and sexual relationships, and by being relevant to all regardless of sexual lifestyle, it addresses some of the gaps in current measurement design

Factors shaping the timing of later entry into parenthood: narratives of choice and constraint

Objective: This study explores the choices and constraints affecting timing of parenthood among those who became parents in their mid-thirties and early forties and how their fertility decisions were both affected by and negotiated within the interplay of different temporal frameworks. Background: Recent decades have seen a trend towards postponement of parenthood in many countries. Explanations for this delay include structural factors, changing social norms and the influence of the social meanings of age. The study assesses the influence of these factors on perceptions of the ‘right’ time to become parents. Method: The study draws on qualitative interviews with 23 women and men who participated in the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) survey and had a first child when they were aged between 33 and 46. Results: Prerequisites for parenthood were seen as financial security, a suitable home and a steady relationship. Educational attainment and the achievement of personal and lifestyle goals affected the age at which parenthood was considered as were individual circumstances. Age was less influential than life stage as a criterion for readiness although, for women, chronological age was a decisive factor. Conclusions: Choice in shaping personal biographies was greater among participants than it would have been for previous generations but its consequences acted to constrain options regarding the timing of parenthood. Time taken to fulfil personal and professional ambitions, changing social norms regarding the appropriate age for parenthood as well as individual and structural factors resulted in less predictable life trajectories.</p

Sexual function in 16- to 21-year-olds in Britain

Purpose: Concern about young people's sexuality is focused on the need to prevent harmful outcomes such as sexually transmitted infections and unplanned pregnancy. Although the benefit of a broader perspective is recognized, data on other aspects of sexuality, particularly sexual function, are scant. We sought to address this gap by measuring the population prevalence of sexual function problems, help seeking, and avoidance of sex in young people. Methods: A cross-sectional stratified probability sample survey (Natsal-3) of 15,162 women and men in Britain (response rate: 57.7%), using computer-assisted self-interviews. Data come from 1875 (71.9%) sexually active, and 517 sexually inactive (18.7%), participants aged 16–21 years. Measures were single items from a validated measure of sexual function (the Natsal-SF). Results: Among sexually active 16- to 21-year-old participants, 9.1% of men and 13.4% of women reported a distressing sexual problem lasting 3 months or more in the last year. Most common among men was reaching a climax too quickly (4.5%), and among women was difficulty in reaching climax (6.3%). Just over a third (35.5%) of men and 42.3% of women reporting a problem had sought help, but rarely from professional sources. Among those who had not had sex in the last year, just &gt;10% of young men and women said they had avoided sex because of sexual difficulties. Conclusions: Distressing sexual function problems are reported by a sizeable minority of sexually active young people. Education is required, and counseling should be available, to prevent lack of knowledge, anxiety, and shame progressing into lifelong sexual difficulties

Forming new sex partnerships while overseas: findings from the third British national survey of sexual attitudes & lifestyles (Natsal-3)

Objectives: Travelling away from home presents opportunities for new sexual partnerships, which may be associated with sexually transmitted infection (STI) risk. We examined the prevalence of, and factors associated with, reporting new sexual partner(s) while overseas, and whether this differed by partners’ region of residence. Methods: We analysed data from 12 530 men and women aged 16–74 years reporting ≥1 sexual partner(s) in the past 5 years in Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a probability survey undertaken 2010–2012. Results: 9.2% (95% CI 8.3% to 10.1%) of men and 5.3% (4.8% to 5.8%) of women reported new sexual partner(s) while overseas in the past 5 years. This was strongly associated with higher partner numbers and other sexual and health risk behaviours. Among those with new partners while overseas, 72% of men and 58% of women reported partner(s) who were not UK residents. Compared with those having only UK partners while abroad, these people were more likely to identify as ‘White Other’ or ‘Non-White’ (vs White British ethnicity), report higher partner numbers, new partners from outside the UK while in the UK and paying for sex (men only) all in the past 5 years. There was no difference in reporting STI diagnosis/es during this time period. Conclusions: Reporting new partners while overseas was associated with a range of sexual risk behaviours. Advice on sexual health should be included as part of holistic health advice for all travellers, regardless of age, destination or reason for travel

Why Do Men Report More Opposite-Sex Sexual Partners Than Women? Analysis of the Gender Discrepancy in a British National Probability Survey.

In a closed population and defined time period, the mean number of opposite-sex partners reported by men and women should be equal. However, in all surveys, men report more partners. This inconsistency is pivotal to debate about the reliability of self-reported sexual behavior. We used data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a probability sample survey of the British population, to investigate the extent to which survey sampling, accounting strategies (e.g., estimating versus counting), and (mis)reporting due to social norms might explain the inconsistency. Men reported a mean of 14.14 lifetime partners; women reported 7.12. The gender gap of 7.02 reduced to 5.47 after capping the lifetime partner number at the 99th percentile. In addition, adjusting for counting versus estimation reduced the gender gap to 3.24, and further adjusting for sexual attitudes narrowed it to 2.63. Together, these may account for almost two-thirds of the gender disparity. Sampling explanations (e.g., non-U.K.-resident partners included in counts; sex workers underrepresented) had modest effects. The findings underscore the need for survey methods that facilitate candid reporting and suggest that approaches to encourage counting rather than estimating may be helpful. This study is novel in interrogating a range of potential explanations within the same nationally representative data set

Heterosexual Practices Among Young People in Britain: Evidence From Three National Surveys of Sexual Attitudes and Lifestyles.

PURPOSE: To describe time trends and current patterns in sexual practices with opposite-sex partners among men and women aged 16-24 years in Britain. METHODS: Complex survey analyses of cross-sectional probability survey data from three British National Surveys of Sexual Attitudes and Lifestyles (Natsal), conducted approximately decennially 1990-2012, involving interviews with 45,199 people in total. RESULTS: Birth cohort analysis showed a decline in the median age at first sexual experience and first intercourse since the midtwentieth century and a narrowing of the interval between these events. Comparison of data from Natsals 1, 2, and 3 showed increases in the prevalence of ever experience of oral and anal sex among 16- to 24-year-olds, which were more marked among older respondents in this age group between Natsals 1 and 2, and among younger respondents between Natsals 2 and 3. Among the sexually active, vaginal and oral sex remained the most common combination of practices reported in the past year. The proportion reporting a past-year repertoire of vaginal, oral, and anal sex rose from approximately one in 10 in 1990-1991 to approximately one in four men and one in five women in 2010-2012. In the latest survey, heterosexual experience of practices was positively associated with bisexual attraction among women. CONCLUSIONS: Recent decades have seen an earlier age at initiation of partnered sexual experiences and increased diversity in heterosexual practices among young people. Keeping pace with trends in sexual practices is necessary to safeguard young people's health and to support them in increasing their sexual well-being

What is sexual wellbeing and why does it matter for public health?

Sexual health has provided a guiding framework for addressing sexuality in public health for several decades. Although the WHO definition of sexual health is revolutionary in acknowledging positive sexuality, public health approaches remain focused on risk and adverse outcomes. The long-standing conflation of sexual health and sexual wellbeing has affected our ability to address everyday sexual issues. This Viewpoint provides a way forward to resolve this impasse. We propose sexual wellbeing as a distinct and revolutionary concept that can be operationalised as a seven-domain model. We situate sexual wellbeing alongside sexual health, sexual justice, and sexual pleasure as one of four pillars of public health enquiry. We argue that sexual wellbeing is imperative to public health as a marker of health equity, a meaningful population indicator of wellbeing, a means to capture population trends distinct from sexual health, and an opportunity to refocus the ethics, form, and practices of public health

Balancing risk, intimacy and (non)compliance: a qualitative study of sex across household during COVID-19 social restrictions

Government controls over intimate relationships, imposed to limit the spread of Sars-CoV-2, were unprecedented in modern times. This study draws on data from qualitative interviews with 18 participants in Natsal-COVID, a quasi-representative web-panel survey of the British population (n = 6,654 people), reporting that they had sex with someone from outside their household in the preceding four weeks; a period in which contact between households was restricted in the UK. Whilst only 10% of people reported sexual contact outside their household, among single people and those in non-cohabiting relationships, rates were much higher (Natsal-COVID). Our findings show that individuals did not take decisions to meet up with sexual partners lightly. Participants were motivated by needs-for connection, security, intimacy and a sense of normality. People balanced risks-of catching COVID-19, social judgement and punishment for rule-breaking-against other perceived risks, including to their mental health or relationships. We used situated rationality and social action theories of risk to demonstrate that people weighed up risk in socially situated ways and exhibited complex decision-making when deciding not to comply with restrictions. Understanding motivations for non-compliance is crucial to informing future public health messaging which accounts for the needs and circumstances of all population members

A peer-led, school-based social network intervention for young people in the UK, promoting sexual health via social media and conversations with friends: intervention development and optimisation of STASH

BACKGROUND: The quality of school-based sex and relationships education (SRE) is variable in the UK. Digitally-based interventions can usefully supplement teacher-delivered lessons and positively impact sexual health knowledge. Designed to address gaps in core SRE knowledge, STASH (Sexually Transmitted infections And Sexual Health) is a peer-led social network intervention adapted from the successful ASSIST (A Stop Smoking in Schools Trial) model, and based on Diffusion of Innovation theory. This paper describes how the STASH intervention was developed and refined. METHODS: Drawing on the Six Steps in Quality Intervention Development (6SQuID) framework, we tested a provisional programme theory through three iterative stages -: 1) evidence synthesis; 2) intervention co-production; and 3) adaptation - which incorporated evidence review, stakeholder consultation, and website co-development and piloting with young people, sexual health specialists, and educators. Multi-method results were analysed in a matrix of commonalities and differences. RESULTS: Over 21 months, intervention development comprised 20 activities within the three stages. 1) We identified gaps in SRE provision and online resources (e.g. around sexual consent, pleasure, digital literacy), and confirmed critical components including the core ASSIST peer nomination process, the support of schools, and alignment to the national curriculum. We reviewed candidate social media platforms, ruling out all except Facebook on basis of functionality restrictions which precluded their use for our purposes. 2) Drawing on these findings, as well as relevant behaviour change theories and core elements of the ASSIST model, we co-developed new content with young people and other stakeholders, tailored to sexual health and to delivery via closed Facebook groups, as well as face-to-face conversations. 3) A pilot in one school highlighted practical considerations, including around peer nomination, recruitment, awareness raising, and boundaries to message sharing. From this, a revised STASH intervention and programme theory were co-developed with stakeholders. CONCLUSIONS: STASH intervention development required extensive adaptation from the ASSIST model. Although labour intensive, our robust co-development approach ensured that an optimised intervention was taken forward for feasibility testing. Evidencing a rigorous approach to operationalising existing intervention development guidance, this paper also highlights the significance of balancing competing stakeholder concerns, resource availability, and an ever-changing landscape for implementation. TRIAL REGISTRATION: ISRCTN97369178