NSSHB study provides update on contemporary Americans' sexual behaviors

Findings from the largest nationally representative study of sexual and sexual-health behaviors ever fielded, conducted by Indiana University sexual health researchers, provides an updated and much needed snapshot of contemporary Americans' sexual behaviors, including a description of more than 40 combinations of sexual acts that people perform during sexual events, patterns of condom use by adolescents and adults, and the percentage of Americans participating in same-sex encounters.

The National Survey of Sexual Health and Behavior (NSSHB) was conducted by researchers from the Center for Sexual Health Promotion (CSHP) in Indiana University's School of Health, Physical Education, and Recreation (HPER).

The NSSHB is one of the most comprehensive studies on these topics in almost two decades and documents the sexual experiences and condom-use behaviors of 5,865 adolescents and adults ages 14 to 94.

Initial findings from the survey, presented in nine separate research articles, were published on Oct. 1 in a special issue of The Journal of Sexual Medicine, a leading peer-reviewed journal in the area of urology and sexual health. The issue also includes commentaries offering perspectives on the study from leading U.S. sexual health authorities, including former U.S. Surgeon General Dr. Joycelyn Elders, Dr. Kevin Fenton, Director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the national Centers for Disease Control and Prevention (CDC), and Lynn Barclay, President and CEO of the American Social Health Association.

"This survey is one of the most expansive nationally representative studies of sexual behavior and condom use ever conducted, given the 80-year span of ages," said Michael Reece, director of the Center for Sexual Health Promotion. "These data about sexual behaviors and condom use in contemporary America are critically needed by medical and public health professionals who are on the front lines addressing issues such as HIV, sexually transmissible infections and unintended pregnancy."

According to the study's findings, one of four acts of vaginal intercourse are condom protected in the U.S. (one in three among singles).

"These data, when compared to other studies in the recent past, suggest that although condom use has increased among some groups, efforts to promote the use of condoms to sexually active individuals should remain a public health priority," Reece said.

Researchers believe the findings will be of interest to the general public, as well as to health professionals.

"People are often curious about others' sex lives," said Debby Herbenick, associate director of the CSHP. "They want to know how often men and women in different age groups have sex, the types of sex they engage in, and whether they are enjoying it or experiencing sexual difficulties. Our data provide answers to these common sex questions and demonstrate how sex has changed in the nearly 20 years since the last study of its kind."

Herbenick said the study helps both the public and professionals to understand how condom use patterns vary across these different stages in people's relationships and across ages, adding that "findings show that condoms are used twice as often with casual sexual partners as with relationship partners, a trend that is consistent for both men and women across age groups that span 50 years."

The survey indicates that there is enormous variability in the sexual repertoires of U.S. adults now, and adult men and women rarely engage in just one sex act when they have sex. While vaginal intercourse is still the most common sexual behavior reported by adults, many sexual events do not involve intercourse and include only partnered masturbation or oral sex. When it comes to responsible sexual behaviors, condom use is higher among black and Hispanic Americans than among white Americans and those from other racial groups.

A unique feature of the study was the inclusion of adolescent men and women. Dennis Fortenberry, M.D., professor of pediatrics in the IU School of Medicine, led the adolescent aspects of the study.

"Many surveys of adolescent sexual behavior create an impression that adolescents are becoming sexually active at younger ages, and that most teens are sexually active," Fortenberry said. "Our data show that partnered sexual behaviors are important but by no means pervasive aspects of adolescents' lives. In fact, many contemporary adolescents are being responsible by abstaining or by using condoms when having sex."

Additional key findings highlighted in the collection of papers include:

• There is enormous variability in the sexual repertoires of U.S. adults, with more than 40 combinations of sexual activity described at adults' most recent sexual event.

• Many older adults continue to have active pleasurable sex lives, reporting a range of different behaviors and partner types, however adults over the age of 40 have the lowest rates of condom use. Although these individuals may not be as concerned about pregnancy, this suggests the need to enhance education efforts for older individuals regarding STI risks and prevention.

• About 85 percent of men report that their partner had an orgasm at the most recent sexual event; this compares to the 64 percent of women who report having had an orgasm at their most recent sexual event. (A difference that is too large to be accounted for by some of the men having had male partners at their most recent event.)

• Men are more likely to orgasm when sex includes vaginal intercourse; women are more likely to orgasm when they engage in a variety of sex acts and when oral sex or vaginal intercourse is included.

• While about 7 percent of adult women and 8 percent of men identify as gay, lesbian or bisexual, the proportion of individuals in the U.S. who have had same-gender sexual interactions at some point in their lives is higher.

• At any given point in time, most U.S. adolescents are not engaging in partnered sexual behavior. While 40 percent of 17 year-old males reported vaginal intercourse in the past year, only 27 percent reported the same in the past 90 days.

• Adults using a condom for intercourse were just as likely to rate the sexual extent positively in terms of arousal, pleasure and orgasm than when having intercourse without one.