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The Australian Study of Health and Relationships is a large national population-representative survey of sexual behavior and attitudes conducted every decade. We describe experiences of sexual difficulties lasting at least a month among Australians surveyed in 2012-2013 and identify changes since the previous survey in 2001-2002. Computer-assisted telephone interviews were completed by 20,091 people aged 16-69 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. [ABSTRACT FROM AUTHOR]

Background Dual protection refers to the simultaneous prevention of sexually transmissible infection (STI) and unintended pregnancies. Optimal contraception and STI prevention strategies sometimes fail to align. Methods Using data from a large nationally representative population-based survey, we analysed the contraception and STI prevention behaviours at the last vaginal intercourse among 2420 heterosexually active women aged 16-34years who had participated in the Second Australian Study of Health and Relationships, 2012-13. Results At their last vaginal intercourse, most women (95%) used contraception and half (49%) used condoms, either as a sole multipurpose method or in conjunction with another type of contraception. Condom use was highest (72%) among women whose most recent partner was a casual or occasional partner, followed by women with a regular partner (59%) and women with a cohabiting regular partner (40%). One-third of the women (34%) used condoms as a sole method, and 14% used oral contraceptives together with a condom. Few women used implants or intrauterine devices (8%) and, among them, very few women also used condoms (<1%). Among the women who used a condom at their last vaginal intercourse, 49% reported both the correct use for STI prevention and consistent condom use during the previous 6months. Among women using condoms, correct and consistent use was also highest among women whose most recent partner was a casual or occasional partner (76%). Conclusions Although almost all women used contraception and half used dual protection, few benefited from the protective effects of using condoms together with highly effective contraception. [ABSTRACT FROM AUTHOR]

Intoxication can be a factor in unwanted sex, but research on the extent of the issue in both women and men is limited. We assessed the prevalence, correlates, and 10-year time-trends of unwanted sex due to intoxication among a representative sample of 4,279 women and 3,875 men aged 16–69 years in Australia and considered how these vary by gender. In 2012–13, 16% of women and 10% of men reported ever having had a sexual experience when they "did not want to because they were too drunk or high at the time." For both women and men, this was associated with younger age, bisexual activity, and reports of lifetime injection drug use, sexually transmitted infections, and forced sex. Among women only, it was associated with drinking above guideline levels and ever having terminated a pregnancy. Among men only, it was associated with current tobacco smoking, elevated psychosocial distress, and poor general health. Compared with 2001–02 data, fewer men reported unwanted intoxicated sex, while there were no changes for women as a whole. Interpreting these findings through an intersectional assemblage framework supports stronger understanding of the multiple factors influencing sexuality and substance use with implications for promoting equity, safety, and sexual health. [ABSTRACT FROM AUTHOR]

Many papers have been written on the process of coming out by individuals with predominantly same-sex sexual orientation but few of these papers have explored the concept of how people negotiate the idea of coming out in prison. We conducted in-depth interviews with 13 prisoners and one ex-prisoner in New South Wales, Australia, who self-identified as gay, homosexual or bisexual men. Data was collected and analysed using an inductive or grounded theory framework since very little was known on the sexual behaviours and identities of Australian prisoners prior to the study and elsewhere. We examined and discussed the lived experiences of prisoners whose disclosure stories were seen to fall under four thematic categories: 'coming out', 'forced out', 'going back in' and 'staying out of the closet' on entering prison. Respondents were required continuously and contextually to manage their sexual identities and disclosure to different audiences while incarcerated. Findings suggest that the prison environment and its attendant heteronormative values and hyper-masculine culture, apply significant pressure on gay and bisexual men on how to manage their sexual identities and disclose their sexuality in prison. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Over a decade after emergency contraceptive pills (ECPs) became available without a prescription, the rate of unintended pregnancies remains high in many settings. Understanding women's experiences and perceptions of ECPs may provide insights into this underutilization. We systematically searched databases to identify qualitative and quantitative primary studies about women's beliefs, knowledge, and experiences of ECPs in Australia. Findings demonstrate persistent misunderstandings around access, how ECPs work, and a moral discourse around acceptable versus unacceptable use. Addressing knowledge and the stigma around ECPs use is fundamental to increasing the use of this medically safe and effective strategy. [ABSTRACT FROM AUTHOR]

This study investigated differences between the demographic characteristics, participation rates (i.e., agreeing to respond to questions about sexual behavior), and sexual behaviors of landline and mobile phone samples in Australia. A nationally representative sample of Australians aged 18 years and over was recruited via random digit dialing in December 2011 to collect data via computer-assisted telephone interviews. A total of 1012 people (370 men, 642 women) completed a landline interview and 1002 (524 men, 478 women) completed a mobile phone interview. Results revealed that telephone user status was significantly related to all demographic variables: gender, age, educational attainment, area of residence, country of birth, household composition, and current ongoing relationship status. In unadjusted analyses, telephone status was also associated with women's participation rates, participants' number of other-sex sexual partners in the previous year, and women's lifetime sexual experience. However, after controlling for significant demographic factors, telephone status was only independently related to women's participation rates. Post hoc analyses showed that significant, between-group differences for all other sexual behavior outcomes could be explained by demographic covariates. Results also suggested that telephone status may be associated with participation bias in research on sexual behavior. Taken together, these findings highlight the importance of sampling both landline and mobile phone users to improve the representativeness of sexual behavior data collected via telephone interviews. [ABSTRACT FROM AUTHOR]

Background Few studies have examined smoking and female sexual difficulties. The aim of this study was to investigate the association between current tobacco smoking and sexual difficulties in Australian men and women.Methods: Data for this study came from the Second Australian Study of Health and Relationships (2012-13), which includes a representative sample of 18427 sexually active Australian adults (aged 16-69 years). The main study and outcome measures were tobacco smoking and sexual difficulties. A multiple logistic regression analysis was conducted to adjust for potential confounders.Results: Male heavy smokers (>20 cigarettes per day) were significantly more likely than non-smokers to have trouble keeping an erection [adjusted odds ratio (AOR) 4.14, 95% confidence interval (CI) 1.87-9.20; P<0.0001], lack interest in having sex (AOR 2.18, 95% CI 1.20-3.97; P=0.011), have anxiety about performance (AOR 2.46, 95% CI 1.24-4.86; P=0.010) and be unable to come to orgasm (AOR=2.81, 95% CI 1.23-6.42; P=0.015). Female smokers were also significantly more likely than non-smokers to not find sex pleasurable (AOR 1.48, 95% CI 1.05-2.07; P=0.025); and light female smokers were significantly more likely than non-smokers to be unable to come to orgasm (AOR=1.44, 95% CI 1.05-1.98; P=0.025).Conclusions: Current tobacco smoking was associated with sexual difficulties in both men and women. For women, even light smoking was associated with not finding sex pleasurable and being unable to come to orgasm. [ABSTRACT FROM AUTHOR]

We examine the lived experiences of transgender women in Australian men’s and women’s prisons. We draw on Alice Ristroph’s sexual punishments framework to discuss the diversity and ambiguities of sexual experiences reported by participants, and argue for a need to move beyond the dominant narrative of prison rape. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

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Background: Social networking and digital media increasingly have an impact on the lives of young people. We undertook a systematic review and meta-analysis of studies that examined the relationship between exposure to sexually explicit websites (SEWs) and 'sexting' (i.e. sending semi-nude or nude photos from a mobile phone) and the sexual attitudes and practices of young people.Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement, Medline, EMBASE and PsycINFO were searched for papers that described the statistical association between viewing SEWs or sexting by young people (defined as 10-24 years) and their sexual attitudes and behaviours.Results: Fourteen studies, all cross-sectional in design, met the inclusion criteria. Six studies (10352 participants) examined young people's exposure to SEWs and eight (10429 participants) examined sexting. There was substantial variation across studies in exposure and outcome definitions. Meta-analyses found that SEW exposure was correlated with condomless sexual intercourse (odds ratio (OR) 1.23, 95% confidence interval (CI): 1.08-1.38, two studies); sexting was correlated with ever having had sexual intercourse (OR 5.58, 95% CI: 4.46-6.71, five studies), recent sexual activity (OR 4.79, 95% CI: 3.55-6.04, two studies), alcohol and other drug use before sexual intercourse (OR 2.65, 95% CI: 1.99-3.32, two studies) and multiple recent sexual partners (OR 2.79, 95% CI: 1.95-3.63, two studies). Most studies had limited adjustment for important potential confounders.Conclusions: Cross-sectional studies show a strong association between self-reported exposure to sexual content in new media and sexual behaviours in young people. Longitudinal studies would provide a greater opportunity to adjust for confounding, and better insight into the causal pathways underlying the observed associations. [ABSTRACT FROM AUTHOR]

Very little research has focused on men or prisoners as victims of sexual violence. This study provides the first population-based analysis of factors associated with sexual coercion of men in Australian prisons, and the first to use a computer-assisted telephone interview to collect this information in a prison setting. A random sample of men in New South Wales and Queensland prisons were surveyed using computer-assisted telephone interviewing. We asked participants about sexual coercion, defined as being forced or frightened into doing something sexually that was unwanted while in prison. Associations between sexual coercion in prison and sociodemographics, sexual coercion history outside of prison, and prison-related factors were examined. Logistic regression was used to estimate adjusted odds ratios in examining factors associated with sexual coercion in prisons. Of 2626 eligible men, 2000 participated. Participants identifying as non-heterosexual and those with a history of sexual coercion outside prison were found to be most at risk. Those in prison for the first time and those who had spent more than 5 years in prison ever were also more likely to report sexual coercion. Although prison policies and improving prison officer training may help address immediate safety and health concerns of those at risk, given the sensitivity of the issue and likely under-reporting to correctional staff, community-based organizations and prisoner peer-based groups arguably have a role too in providing both preventive and trauma-focused support. [ABSTRACT FROM AUTHOR]

Co-authored by a discourse analyst, a branding expert and medical researchers and practitioners, this paper presents a multimodal discourse analysis of advertisements for contraceptive products in magazines and journals aimed at general practitioners, gynecologists and obstetricians. It combines genre analysis and multimodal image, layout, colour and typography analysis to show how such advertisements link specific types of women to specific products and product attributes and benefits, and how product branding invokes values such as health, sexual freedom, sexuality, femininity, strength and reliability, which combine in different ways to create distinct identities for specific products. The findings show that the way the advertisements link products and users does not align with medical evidence, and that in general they do not represent the full range of factors that play a role in choosing contraceptive methods and products - indeed, they are far removed from the realities of the consultation room. [ABSTRACT FROM AUTHOR]

Objective: To examine the clinical and epidemiological literature addressing contraceptive method change or discontinuation and to assess whether the documented reasons reflected women's experiences.Methods: Major databases including Medline and PsycINFO were searched using keywords related to contraception and discontinuation, adherence and satisfaction, for articles published between January 2003 and February 2013. Studies in developed countries that focused on women of reproductive age and reasons for method change or discontinuation were included. Reasons reported were categorised and examined.Results: A total of 123 papers were reviewed in detail. Medical terminology was generally used to describe reasons for method discontinuation. The top two reported reasons were bleeding and pregnancy, but there was a lack of consensus about the categorisation of reasons. Broad categories that were not self-explanatory were included in more than half of the papers, often without further explanation. Only 12 studies expanded on categories containing 'other', 'non-medical' or 'personal' reasons. Eight papers included categories that attributed discontinuation to the participant, such as 'dissatisfied with method'.Conclusions: Studies of reasons for discontinuation of contraceptives do not well describe women's specific reasons. Studies rely heavily on medical terms and often fail to document women's subjective experiences. Future studies should create an opportunity for women to articulate their non-medical reasons in their own words, including those related to their sexual lives. Furthermore, researchers should distinguish, if possible, between reasons for discontinuation of a method and reasons for ceasing participation in a research study. [ABSTRACT FROM AUTHOR]

Background: Concurrent relationships are a driver of generalised epidemics of sexually transmissible infections (STIs). In Australia, explicit negotiation of agreements about sex outside regular relationships has been recommended in health promotion for gay men but not for heterosexuals. Objective: To ascertain the annual incidence of concurrency among people in ongoing male-female relationships according to their reported expectations of exclusivity. Methods: In a national cohort recruited by household random digit dialling in 2004-05, people aged 16-64 years completed computer-assisted telephone interviews including questions about expectations of sexual exclusivity, discussion and agreements. A year later, those in ongoing sexual relationships (5323 people) were asked about sexual partner numbers in the past year. Results: The huge majority (96%) expected sexual exclusivity of themselves and their partner. However, only 48% of men and 64% of women had discussed the matter and explicitly agreed. Older respondents were less likely to report discussion. Only 1% reported mutually nonexclusive ('open') relationships. A year later, 93% of respondents were still in the same relationship, among whom 4% of men and 2% of women had had sex outside the relationship. Those with agreements that one or both partners could have sex with others were more likely to do so, but the majority of respondents who had sex with someone else were in relationships that were explicitly or implicitly expected to be exclusive. Conclusions: Sexual health promotion should stress the importance of STI testing and establishing agreements about exclusivity before condoms are abandoned in new relationships. [ABSTRACT FROM AUTHOR]

Background: Attitudes towards sex and relationships influence laws about what is and is not permissible and social sanctions against behaviours considered unacceptable. They are an important focus for research given their links to sexual behaviour. The aim of the present study was to describe attitudes towards sex and relationships, to identify correlates of scores on a scale of sexual liberalism and to examine responses to jealousy-evoking scenarios among Australian adults. Methods: Computer-assisted landline and mobile telephone interviews were completed by a population-representative sample of 20 094 men and women aged 16-69 years. The overall participation rate among eligible people was 66.2%. Respondents expressed their agreement with 11 attitude statements, five of which formed a valid scale of liberalism, and also responded to a jealousy-evoking scenario. Results: There was general agreement that premarital sex was acceptable (87%), that sex was important for wellbeing (83%) and that sex outside a committed relationship was unacceptable (83%). Respondents were accepting of homosexual behaviour and abortion and few believed that sex education encouraged earlier sexual activity. More liberal attitudes were associated with: being female; speaking English at home; homosexual or bisexual identity; not being religious; greater education; and higher incomes. Respondents who expressed more liberal attitudes had more diverse patterns of sexual experience. Predicted sex differences were found in response to the jealousyevoking scenario--men were more jealous of a partner having sex with someone else and women were more jealous of a partner forming an emotional attachment -- but responses varied with age. Conclusion: Sexual attitudes of Australians largely support a permissive but monogamous paradigm. Since 2002, there has been a shift to less tolerance of sex outside a committed relationship, but greater acceptance of homosexual behaviour. [ABSTRACT FROM AUTHOR]

Current information about numbers of other-sex partners, experiences of different heterosexual behaviours and the recent heterosexual experiences among a representative sample of Australian adults is needed. It is not known whether these practices have changed between 2001-02 and 2012-13. Methods: Computer-assisted telephone interviews were completed by a representative sample of 9963 men and 10 131 women aged 16-69 years from all states and territories. The overall participation rate among eligible people was 66.2%. Results: Men reported more sexual partners than women, although the lifetime number of heterosexual partners reported by women increased significantly between 2001-02 and 2012-13. In 2012-13, 14.7% of men and 8.6% of women reported two or more sexual partners in the last year. Reporting multiple partners was significantly associated with being younger, being bisexual, living in major cities, having a lower income, having a blue-collar occupation and not being married. The proportion of respondents reporting ever having had oral sex or anal intercourse increased significantly since the last survey. At the last heterosexual encounter, 91.9% of men and 66.2% of women had an orgasm, oral sex was reported in only approximately one in four encounters and anal intercourse was uncommon. Conclusion: There were increases between 2001-02 and 2012-13 in partner numbers among women and in the lifetime experience of oral and anal sex. The patterns of heterosexual experience in Australia are similar to those found in studies of representative samples in other countries. [ABSTRACT FROM AUTHOR]

The article compares the First and Second Australian Studies of Health and Relationships (ASHR). In ASHR1 and ASHR2, the method of data collection, that is, computer-assisted telephone interviews (CATI) and the majority of the questionnaire items were identical. In ASHR1 and ASHR2, the patterns of demographic correlates of the various results tended to be similar.

Background: The aim of this study is to describe homosexual experience and characteristics of recent homosexual encounters among Australian adults and identify changes between 2001-02 and 2012-13. Methods: Computer-assisted telephone interviews were completed by a representative sample of 20 094 men and women aged 16-69 years and the participation rate among eligible people was 66.2%. Respondents indicated the number of same-sex partners they had had in their lifetime and in the last 12 months. Those who reported any homosexual experience were asked the age at which this first occurred and about characteristics of the first and most recent homosexual encounter. Results: Reporting ever having same-sex experience was more common in women (13.5%) than in men (6.5%, P < 0.001). Among these people, men reported more lifetime and recent same-sex partners than women (P < 0.001). Same-sex experience was associated with some but not all indices of higher socioeconomic status. In men, it was associated with living in a major city (P = 0.02) and in women, it was associated with younger (<30 years) age and with very low income (P < 0.001). Men were younger than women at their first homosexual encounter (P = 0.005). Women were more likely than men to have their first same-sex encounter with a regular partner. For women but not men, there was a significant increase in the proportion reporting same-sex experience since 2001-02. Conclusion: Same-sex experience is not uncommon and is increasing in prevalence in young Australian women. The high number of same-sex partners among homosexual and bisexual men places them at greater risk of sexually transmissible infection. [ABSTRACT FROM AUTHOR]

Background: Behavioural and other aspects of sexuality are not always consistent. This study describes the prevalence and overlap of same-sex and other-sex attraction and experience and of different sexual identities in Australia. Methods: Computer-assisted telephone interviews were completed by a representative sample of 20 094 men and women aged 16-69 years recruited by landline and mobile phone random-digit dialling with a response rate (participation rate among eligible people) of 66.2%. Respondents were asked about their sexual identity ('Do you think of yourself as' heterosexual/straight, homosexual/gay, bisexual, etc.) and the sex of people with whom they had ever had sexual contact and to whom they had felt sexually attracted. Results: Men and women had different patterns of sexual identity. Although the majority of people identified as heterosexual (97% men, 96% women), women were more likely than men to identify as bisexual. Women were less likely than men to report exclusively other-sex or same-sex attraction and experience; 9% of men and 19% of women had some history of same-sex attraction and/or experience. Sexual attraction and experience did not necessarily correspond. Homosexual/gay identity was more common among men with tertiary education and living in cities and less common among men with blue-collar jobs. Many gay men (53%) and lesbians (76%) had some experience with an other-sex partner. More women identified as lesbian or bisexual than in 2001-02. Similarly, more women reported same-sex experience and same-sex attraction. Conclusion: In Australia, men are more likely than women to report exclusive same-sex attraction and experience, although women are more likely than men to report any non-heterosexual identity, experience and attraction. Whether this is a feature of the plasticity of female sexuality or due to lesser stigma than for men is unknown. [ABSTRACT FROM AUTHOR]

Background: Sexually transmissible infections (STIs) present a substantial public health burden, and are related to modifiable sexual behaviours. Methods: Computer-assisted telephone interviews were completed by a population-representative sample of 20 094 men and women aged 16-69 years. The overall participation rate among eligible people was 66.2%. Respondents were asked questions regarding their knowledge about, self-reported history of, and testing for STIs. Results: STI knowledge was better in women, the young, people of higher socioeconomic status, those with a variety of indicators of being at high STI risk and those with a history of receiving sex education in school. Approximately one in six men and women reported a lifetime history of an STI. A history of STI testing in the last year was reported by ~one in six (17%) women and one in eight men (13%) and higher rates of testing in women were reported in most high-risk groups. The highest rates of STI testing (61%) and HIV testing (89%) were reported in homosexual men. Conclusion: Knowledge of STI-related health consequences and transmission is improving in Australians, and rates of STI testing were relatively high but were higher in women than in men. Further increases in testing rates in both sexes will be required to facilitate the early diagnosis and treatment of STIs, which is a cornerstone of STI control. [ABSTRACT FROM AUTHOR]

Background: This study describes the prevalence of (solo) masturbation, paying for sex and a range of other sexual practices among Australians. Methods: A representative sample of 20 094 men and women aged 16-69 years (participation rate among eligible people, 66.2%) were recruited by landline and mobile phone random-digit dialling and computer-assisted telephone interviews in 2012-13. Results: Many respondents (men, 72%; women, 42%) had masturbated in the past year. Half (51%) of the men and 24% of women had masturbated in the past 4 weeks. In the past year, more than two-fifths of respondents (men, 63%; women, 20%) had looked at pornography in any medium. Approximately 15% of men and 21% of women had used a sex toy. Digital-anal stimulation with a partner was practised by 19% of men and 15% of women, and oral-anal stimulation by 7% of men and 4% of women. Sexual role playing or dressing up were engaged in by 7-8%. Online sex, swinging, group sex, BDSM (bondage and discipline, 'sadomasochism' or dominance and submission) and fisting (rectal or vaginal) were each engaged in by less than 3% of the sample. Seventeen per cent of men said they had ever paid for sex; 2% had done so in the past year. Conclusion: Most of the solo practices studied were engaged in by more men than women, but women were more likely to have used a sex toy. Autoerotic activities are both substitutes for partnered sex and additional sources of pleasure for people with sexual partners. [ABSTRACT FROM AUTHOR]

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 10 131 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 20 094 people (10 056 men and 10 038 women). The sample was broadly representative of the Australian population, although as in most surveys, people with higher education and higher status occupations were overrepresented. 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. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to describe important characteristics of Australian adults' heterosexual regular sexual relationships and examine how these characteristics have changed since 2002. Methods: Computer-assisted landline and mobile telephone interviews were completed by a representative sample of 20 094 Australian residents aged 16-69 years. The participation rate among eligible people was 66.2%. Data were collected on respondents' social and demographic characteristics, relationship status and duration, cohabitation status, partner's age, contraception use, expectations about sexual exclusivity, sexual partners in the previous year, actual and ideal frequencies of sex and levels of physical pleasure and emotional satisfaction in their relationships. Results: Most sexually active respondents 89%; 74% of all respondents, were in a heterosexual regular relationship. Most (97%) expected sexual exclusivity in their relationships, with 3% reporting extradyadic sex in the previous year. Respondents reported an average frequency of sex of 1.44 times per week, with most reporting very high levels of physical pleasure (men, 88%; women, 76%) and emotional satisfaction (men, 86%; women, 84%) in their relationships. Comparisons with data from the First Australian Study of Health and Relationships revealed that significantly more sexually active men were in a relationship in the current survey; that respondents' average frequency of sex was significantly lower; and that women's reports of extreme emotional satisfaction had risen. Otherwise, results were consistent with those of the first study. Conclusions: In general, results suggested that the characteristics of Australians' heterosexual relationships changed little between 2002 and 2013. Despite a decline in respondents' average weekly frequency of sex, the majority of respondents reported being in a highly satisfying, sexually exclusive relationship. [ABSTRACT FROM AUTHOR]

Background: Current information about the characteristics of Australian adults' first vaginal intercourse and contraception or precautions used on that occasion is needed, as well as whether these characteristics have changed between 2001-02 and 2012-13. Methods: Computer-assisted telephone interviews were completed by a representative sample of 20 094 men and women aged 16-69 years. The overall participation rate among eligible people was 66.2%. Respondents indicated their age at first vaginal intercourse and first oral sex. Those who reported vaginal intercourse were asked the age of their partner, their relationship to their partner, the duration of this relationship, and what contraception or precautions (if any) were used. Results: There was a significant decline in the median age of first vaginal intercourse for both men and women among those born between the 1940s and the 1960s, but no further decline since. There has also been a significant increase in the use of protection at first vaginal intercourse, from less than 20% of men and women in the 1950s to over 90% in the 2000s. For men and women, first vaginal sex before age 16 years was significantly associated with a greater number of lifetime and recent sexual partners, and a greater likelihood of having had a sexually transmitted infection. Conclusion: Given the earlier age at first vaginal intercourse, sex education should begin earlier so that all young people have information about contraception and disease prevention before they begin their sexual careers. [ABSTRACT FROM AUTHOR]

It is important to have current reliable estimates of the prevalence, correlates and consequences of sexual coercion among a representative sample of Australian adults and to identify changes over time in prevalence and consequences. Methods: Computer-assisted telephone interviews were completed by a representative sample of 20 094 Australian men and women aged 16-69 years. The participation rate among eligible people was 66.2%. Results: Sexual coercion (i.e. being forced or frightened into sexual activity) was reported by 4.2% of men and 22.4% of women. Sexual coercion when aged -16 years was reported by 2.0% of men and 11.5% of women. Correlates of sexual coercion were similar for men and women. Those who had been coerced reported greater psychosocial distress, were more likely to smoke, were more anxious about sex and more likely to have acquired a sexually transmissible infection. Few people had talked to others about their experiences of sexual coercion and fewer had talked to a professional. There were no significant differences between the First and Second Australian Study of Health and Relationships in whether men or women had experienced coercion, talked to anyone about this or talked to a counsellor or psychologist. Conclusion: Sexual coercion has detrimental effects on various aspects of people's lives. It usually occurs at the ages at which people become sexually active. There is a need to reduce the incidence of sexual coercion, better identify experiences of sexual coercion, and provide accessible services to minimise the detrimental effects of sexual coercion. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

In a national telephone-based survey, information on sexual behaviour and outcomes were collected from 20091 randomly selected Australians in 2012-13. Data were weighted and analysed to determine the proportion of those who had received school-based sex education and to examine the associations between sex education and sexual health outcomes, specifically a history of a sexually transmissible infection (STI), early pregnancy, contraception use at first sex, and level of STI knowledge. Just over half the respondents (53%; n=19836) reported receiving sex education that included information about condoms and contraception. Using logistic regression analysis after adjusting for age, education and non-English-speaking background, we found that sex education was strongly associated with increased odds of using contraception at first vaginal intercourse (odds ratio (OR)=1.57; 95% confidence interval (CI) 1.44-1.71; P<0.001) and higher levels of STI knowledge (OR=1.75; 95% CI 1.46-2.12; P<0.001). [ABSTRACT FROM AUTHOR]

This study investigated demographic predictors of consistency and change in heterosexual people's attitudes toward homosexual behavior. A nationally representative sample of Australian men and women were recruited via random digit dialling in 2004 through 2005. Participants completed annual computer-assisted telephone interviews over the next five years. Questions about attitudes toward male and female homosexual behavior were assessed at Wave 1 (2004–2005) and Wave 3 (2006–2007) of the study. The majority of the sample reported tolerance of both male and female homosexual behavior (with women slightly more tolerant than men). Multivariate analyses showed that those who regularly attended religious services were more likely to consistently disapprove of homosexual behavior and more likely to change from tolerant to disapproving. Among those who were initially tolerant, younger respondents and those with higher educations were less likely to become homophobic. The results of this study show that individual attitudes toward homosexual behavior are open to change, particularly toward a more tolerant position. Religiosity appears to be consistently associated with the development and reinforcement of homophobic tendencies. [ABSTRACT FROM AUTHOR]

This study presents data on the prevalence, incidence, and persistence/recurrence of 8 sexual difficulties among men. Participants were 3,157 Australian men who were administered 2 computer-assisted interviews approximately 12 months apart. Analyses were based on a weighted sample of 2,158 men who were 20-64 years of age, sexually active in the past 12 months, and in the same heterosexual relationship at both interviews. Upon recruitment, a third of men (34%) reported having 1 or more sexual difficulties. At follow-up, 21% reported a new sexual difficulty. The 2 highest incident difficulties were "lacking interest in having sex" (11%) and "reaching orgasm too quickly" (7%). In addition, 51% of men with 1 or more sexual difficulties at recruitment reported having at least 1 of these difficulties again at follow-up. While "trouble keeping an erection" had the highest persistence/recurrence (48%), "taking too long to orgasm" had the lowest (24%). Logistic regression modeling revealed a greater incidence oat orgasmic difficulties among older and less educated men. There were few sociodemographic predictors of persistence/recurrence. These data should assist clinicians and other health service providers in identifying the potential challenges faced by men who experience sexual difficulties. [ABSTRACT FROM AUTHOR]

ABSTRACT. One hundred online sexual health forum pages were analyzed to identify sexual health concerns of young people. Pages collected from five popular forum Web sites posted in August 2011 were indexed, noting demographics, primary complaint, type of question and response, misconceptions of medical concepts, and general keywords. Gaps in knowledge were identified regarding tampon use, menstrual fluid, hormonal contraception, sexually transmitted infections, and signs of pregnancy. Forum participants searched online using symptoms, a finding that suggests Web sites providing sexual health information to young people should be organized by symptom. Sex education should inform students about transmission risks associated with common sexual practices rather than focusing on diseases and should teach how to find and access local services. [ABSTRACT FROM AUTHOR]

ABSTRACT. One hundred online sexual health forum pages were analyzed to identify sexual health concerns of young people. Pages collected from five popular forum Web sites posted in August 2011 were indexed, noting demographics, primary complaint, type of question and response, misconceptions of medical concepts, and general keywords. Gaps in knowledge were identified regarding tampon use, menstrual fluid, hormonal contraception, sexually transmitted infections, and signs of pregnancy. Forum participants searched online using symptoms, a finding that suggests Web sites providing sexual health information to young people should be organized by symptom. Sex education should inform students about transmission risks associated with common sexual practices rather than focusing on diseases and should teach how to find and access local services. [ABSTRACT FROM AUTHOR]

Background: We report the prevalence of penile implants among prisoners and determine the independent predictors for having penile implants. Questions on penile implants were included in the Sexual Health and Attitudes of Australian Prisoners (SHAAP) survey following concerns raised by prison health staff that increasing numbers of prisoners reported having penile implants while in prison. Methods: Computer-Assisted Telephone Interviewing (CATI) of a random sample of prisoners was carried out in 41 prisons in New South Wales and Queensland (Australia). Men were asked, "Have you ever inserted or implanted an object under the skin of your penis?" If they responded Yes: "Have you ever done so while you were in prison?" Univariate logistic regression and logistic regression were used to determine the factors associated with penile implants. Results: A total of 2,018 male prisoners were surveyed, aged between 18 and 65 years, and 118 (5.8%) reported that they had inserted or implanted an object under the skin of their penis. Of these men, 87 (73%) had this done while they were in prison. In the multivariate analysis, a younger age, birth in an Asian country, and prior incarceration were all significantly associated with penile implants (p<0.001). Men with penile implants were also more likely to report being paid for sex (p<0.001), to have had body piercings (p<0.001) or tattoos in prison (p<0.001), and to have taken non-prescription drugs while in prison (p<0.05). Conclusions: Penile implants appear to be fairly common among prisoners and are associated with risky sexual and drug use practices. As most of these penile implants are inserted in prison, these men are at risk of blood borne viruses and wound infection. Harm reduction and infection control strategies need to be developed to address this potential risk. [ABSTRACT FROM AUTHOR]

This study examined whether sexual/relationship satisfaction are differentially associated with mental health issues. Using data from a population-based computer-assisted telephone survey, the authors included in this study 3,800 respondents who had a regular heterosexual partner. The authors used 2 methods of scoring the K6 to produce measures of moderate psychological distress and serious psychological distress. Overall, 8.8% of men and 12.1% of women were classified as having moderate psychological distress, whereas 1.6% of men and 3.2% of women were classified as currently experiencing serious psychological distress. The association between satisfaction and mental health was influenced by sex and the severity of the mental health issue but not by type of satisfaction. After adjusting for demographic differences in mental health, low ratings of sexual/relationship satisfaction were both consistently associated with higher levels of moderate psychological distress in men and women and higher proportions of serious psychological distress in men. Although women may be able to resolve their satisfaction issues during less severe stages of psychological distress, for men there was a strong association between low sexual/relationship satisfaction and serious psychological distress. [ABSTRACT FROM PUBLISHER]

Background: Organised abuse (where multiple adults conspire to sexually abuse multiple children) has been one of the most controversial issues in debates over mental health practice with survivors of child sexual abuse. Aims: The aim of this paper is to summarise and analyse the available prevalence data pertinent to organised abuse and to identify the challenges that organised abuse poses for mental health policy and practice. Methods: Prevalence studies of sexual abuse based on community and clinical samples were reviewed for findings pertinent to organised abuse. Key indicators of organised abuse were selected and summarised on the basis of their association with the known characteristics of organised abuse. The literature regarding the health impacts of these indicators was also reviewed. Results: A minority of people reporting contact sexual abuse in the community report experiences indicative of organised abuse. These indicators are elevated in particular settings and they are associated with poor mental and physical health. Conclusions: Organised abuse is rare but it is associated with poor mental and physical health outcomes. There is currently no source of integrated care for adults with histories of organised abuse. Many survivors end up in prison or homeless, chronically disabled by illness, or dead. [ABSTRACT FROM AUTHOR]

This study investigated the association between sexual practices and duration of a sexual encounter. Using data from a population-based computer-assisted telephone survey of 8,656 Australians aged 16 to 64 years, four distinct patterns of sexual practices among respondents were found: “basic sexual encounter” (involving mainly kissing, cuddling, stroking one's partner and being stroked, and vaginal intercourse), “basic sexual encounter plus oral sex,” “all assessed sexual practices” (all sexual behaviors included in the survey), and “mainly vaginal intercourse” (characterized by lower levels of kissing, cuddling, and stroking). For both men and women, respondents classified in the basic sexual encounter plus oral sex, and all assessed sexual practices clusters reported significantly longer durations than those in the basic sexual encounter group, whereas respondents in the mainly vaginal intercourse cluster reported shorter durations. These differences were found even after allowing for demographic differences in sexual duration—specifically, age and partner type of the most recent opposite-sex partner. These findings add to the understanding of what typically happens in a sexual encounter. Overall, longer sexual encounters appear to be associated with the inclusion of the least common sexual practices—namely, oral sex and self-stimulation. [ABSTRACT FROM PUBLISHER]

This article examines factors influencing English language education, participation and achievement among Karen refugee women in Australia. Data were drawn from ethnographic observations and interviews with 67 participants between 2009 and 2011, collected as part of a larger qualitative study exploring the well-being of Karen refugee women in Sydney. Participants unanimously described difficulty with English language proficiency and communication as the 'number one' problem affecting their well-being. Gendered, cultural and socio-political factors act as barriers to education. We argue that greater sensitivity to refugees' backgrounds, culture and gender is necessary in education. Research is needed into the combined relationships between culture and gender across pre-displacement, displacement and resettlement and the impact of these factors on post-immigration educational opportunities. Training is needed to sensitise educators to the complex issues of refugee resettlement. The paper concludes with recommendations for service provision and policy. [ABSTRACT FROM AUTHOR]

This study presents data on the prevalence, incidence, and persistence/recurrence of 8 sexual difficulties among women. Australian women participated in 2 computer-assisted interviews approximately 12 months apart. Analyses were based on a weighted sample of 2,252 women who were 20–64 years of age, sexually active in the past 12 months, and in the same heterosexual relationship at both interviews. Upon recruitment, two-thirds of women (66%) reported having one or more sexual difficulties. At follow-up, 36% reported a new sexual difficulty. The two highest incident difficulties were “lacking interest in having sex” (26%) and “taking too long to orgasm” (11%). In addition, 68% of women with 1 or more sexual difficulties at recruitment reported having at least 1 of these again at follow-up. Lacking interest in having sex had the highest persistence/recurrence (65%). Logistic regression modeling revealed a lower incidence of sexual difficulties among women in their 40s. Age was also a predictor of the persistence/recurrence, with persistence/recurrence most likely among older women. Tobacco and alcohol use predicted the incidence, but not persistence/recurrence, of lacking interest in sex. Health professionals need to take note of the sociodemographic groups most prone to developing and having persistent/recurrent sexual difficulties. [ABSTRACT FROM AUTHOR]

Estimates of the incidence of sexual coercion in men's prisons are notoriously variable and fraught with conceptual and methodological problems. In 2006-2007, we conducted a computer-assisted telephone survey of a random sample of 2,018 male prisoners in New South Wales and Queensland. Of 2,626 eligible and available inmates, 76.8% consented and provided full responses. We asked about time in prison, sexual experience, attraction and (homo/bi/heterosexual) identity, attitudes, sexual contact with other inmates, reasons for having sex and practices engaged in, and about sexual coercion, including location and number of perpetrators. Most men (95.1%) identified as heterosexual. Of the total sample, 13.5% reported sexual contact with males in their lifetime: 7.8% only outside prison, 2.8% both inside and outside, and 2.7% only inside prison. Later in the interview, 144 men (7.1% of total sample) reported sexual contact with inmates in prison; the majority had few partners and no anal intercourse. Most did so for pleasure, but some for protection, i.e., to avoid assault by someone else. Before incarceration, 32.9% feared sexual assault in prison; 6.9% had been sexually threatened in prison and 2.6% had been sexually coerced ('forced or frightened into doing something sexually that [they] did not want'). Some of those coerced reported no same-sex contact. The majority of prisoners were intolerant of male-to-male sexual activity. The study achieved a high response rate and asked detailed questions to elicit reports of coercion and sex separately. Both consensual sex and sexual assault are less common than is generally believed. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Prison populations are made up of individuals from disadvantaged, often abusive backgrounds, who are more likely to suffer from psychological problems than the general community. Aim This study aimed to determine associations between current psychological distress and history of having experienced sexual coercion and/or physical assault among prisoners in two Australian states (Queensland and New South Wales). Methods We conducted a random sample survey of prisoners by computer-assisted telephone interview. Prisoners were asked about forced sexual encounters in or outside prison, and physical assault in prison. Psychological distress was estimated using a dichotomised score obtained from the Kessler 6-Item Psychological Distress Scale (K6), and a logistic regression analysis was employed to investigate associations. Results A total of 2426 prisoners were interviewed of 3055 prisoners invited to participate, a response rate of 79%. We categorised 236 men (12%) and 63 women (19%) as 'severely' psychologically distressed according to the K6, and 13% of the men and 60% of the women reported that they had been sexually coerced prior to imprisonment. Physical assault in prison was common, reported by 34% of the men and 24% of the women. On multivariate analysis, prisoners were more likely to be psychologically distressed if they had ever been threatened with sexual assault in prison or physically assaulted in prison. Sexual coercion outside prison was an important associate of psychological distress among men but not among women. Conclusions As psychological distress and experiences of assault are closely statistically linked among male prisoners and both are very common among female prisoners, their screening for psychological distress should include efforts to find out about sexual and violent assaults against them both before and during imprisonment. Further, longitudinal research with prisoners is required to establish causal relationships. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Male prison rape and sexual assaults remains a serious and sensitive issue in many countries. Human rights groups claim that sexual assaults among male prisoners have reached pandemic proportions and need to be stopped. Researchers for many years have studied the causes of male sexual assault in prison and offered numerous recommendations on its prevention. Few, however, have presented evidence for a decline in male prisoner sexual assaults and investigated the reasons for the decline. This article provides evidence from population-based surveys of a steady decrease in male prisoner sexual assaults in New South Wales (NSW) between 1996 and 2009. The authors conducted in-depth interviews with former and current inmates, and using a “systems” approach they discuss the complexity of sexual assaults in prison, incorporating a multiplicity of perspectives. In particular, they bring together different sources of data and discuss this in relation to changes in power structures and control in a modern prison, the attitudes of older and younger prisoners, the concept of “duty of care,” introduction of prison drug programs, and prisoner attitudes toward gender and sexuality. In anthropology, the term “system” is used widely for describing sociocultural phenomena of a given society in a holistic manner without reducing the complexity of a given community. [ABSTRACT FROM AUTHOR]

The article discusses a study which compared the attitudes towards sexual issues between prisoners and the general community in Australia. Computer-assisted telephone interviews with 2289 prisoners and 6755 community members with no history of imprisonment were conducted under the study. It was found that the attitudes of prisoners towards sex were more conservative compared with the community. Prisoners showed a higher likelihood to agree with perceptions that abortion and male homosexuality are wrong. Male prisoners were more likely to condemn abortion and male homosexuality compared with female prisoners. Other issues covered by the study included the acceptability of sex before marriage, the importance of an active sex life and private family visits in prisons.

Background: Not much is known about whether women who follow Pap testing recommendations report the same pattern of sexual behavior as women who do not. Methods: Data come from part of a larger population-based computer-assisted telephone survey of 8656 Australians aged 16-64 years resident in Australian households with a fixed telephone line (Australian Longitudinal Study of Health and Relationships [ALSHR]). The main outcome measure in the current study was having had a Pap test in the past 2 years. Results: Data on a weighted sample of 4052 women who reported sexual experience (ever had vaginal intercourse) were analyzed. Overall, 73% of women in the sample reported having a Pap test in the past 2 years. Variables individually associated with Pap testing behavior included age, education, occupation, cohabitation status, residential location, tobacco and alcohol use, body mass index (BMI), lifetime and recent number of opposite sex partners, sexually transmitted infection (STI) history, and condom reliance for contraception. In adjusted analyses, women in their 30s, those who lived with their partner, and nonsmokers were more likely to have had a recent Pap test. Those who drank alcohol at least weekly were more likely to have had a recent test than irregular drinkers or nondrinkers. Women with no sexual partners in the last year were less likely to have had a Pap test, and women who reported a previous STI diagnosis were more likely to have had a Pap test in the past 2 years. Conclusions: There are differences in Pap testing behavior among Australian women related to factors that may affect their risk of developing cervical abnormalities. Younger women and regular smokers were less likely to report a recent test. Screening programs should consider the need to focus recruitment strategies for these women. [ABSTRACT FROM AUTHOR]

Little is known of the extent to which heterosexual couples are satisfied with their current frequency of sex and the degree to which this predicts overall sexual and relationship satisfaction. A population-based survey of 4,290 men and 4,366 women was conducted among Australians aged 16 to 64 years from a range of sociodemographic backgrounds, of whom 3,240 men and 3,304 women were in regular heterosexual relationships. Only 46% of men and 58% of women were satisfied with their current frequency of sex. Dissatisfied men were overwhelmingly likely to desire sex more frequently; among dissatisfied women, only two thirds wanted sex more frequently. Age was a significant factor but only for men, with those aged 35-44 years tending to be least satisfied. Men and women who were dissatisfied with their frequency of sex were also more likely to express overall lower sexual and relationship satisfaction. The authors' findings not only highlight desired frequency of sex as a major factor in satisfaction, but also reveal important gender and other sociodemographic differences that need to be taken into account by researchers and therapists seeking to understand and improve sexual and relationship satisfaction among heterosexual couples. Other issues such as length of time spent having sex and practices engaged in may also be relevant, particularly for women. [ABSTRACT FROM AUTHOR]