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Sexual wellbeing is an important aspect of population health and addressing it as a distinct issue requires a validated measure. Our previous conceptual work identified seven domains of sexual wellbeing: security; respect; self-esteem; resilience; forgiveness; self-determination; and comfort. Here we describe the development and validation of a measure capturing these domains. We build on analysis of 40 semi-structured interviews (reported elsewhere). We operationalised domains into items, and refined them via seven cognitive interviews, workshops and expert review. We then tested the items via two web-based surveys (n=590; n=814). Using data from the first survey we did exploratory factor analysis to assess and eliminate poor performing items. Using data from the second we did confirmatory factor analysis to examine model fit and associations between the item reduced measure and external variables hypothesised to correlate with sexual wellbeing (external validity). A sub-sample (n=113) repeated the second survey after two weeks to evaluate test-retest reliability. Confirmatory factor analysis indicated that a ‘general specific model’ had best fit (RMSEA: 0.064; CFI: 0.975, TLI: 0.962), and functioned equivalently across age groups, genders, sexual orientations and relationship statuses. The final measure comprised 13 items (from an initial set of 25). It was associated with external variables in the directions hypothesised (all p

Using data from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) we examined associations between salivary testosterone (Sal-T) and sexual function and behavior. Single morning saliva samples were self-collected from a subsample of participants aged 18-74 years and analyzed using mass spectrometry. 1,599 men and 2,123 women were included in the analysis (40.6% of those invited to provide a sample). We adjusted for confounders in a stepwise manner: in model 1 we adjusted for age only; model 2 for age, season and relationship status, and model 3 we added BMI and self-reported health. In the fully adjusted models, among men, Sal-T was positively associated with both partnered sex (vaginal sex and concurrent partners) and masturbation. Among women, Sal-T was positively associated with masturbation, the only association with partnered sex was with ever experience of same-sex sex. We found no clear association between Sal-T and sexual function. Our study contributes toward addressing the sparsity of data outside the laboratory on the differences between men and women in the relationship between T and sexual function and behavior. To our knowledge, this is the first population study, among men and women, using a mass spectrometry Sal-T assay to do so.

Although sex education has been found to improve young people’s sexual and reproductive health, no formal programmes exist in Saudi Arabia. This study aims to assess the views of stakeholders on th...

ObjectivesPhysical restrictions imposed to combat COVID-19 dramatically altered sexual lifestyles but the specific impacts on sexual behaviour are still emerging. We investigated physical and virtual sexual activities, sexual frequency and satisfaction in the 4 months following lockdown in Britain in March 2020 and compared with pre-lockdown.MethodsWeighted analyses of web panel survey data collected July/August 2020 from a quota-based sample of 6654 people aged 18–59 years in Britain. Multivariable regression took account of participants’ opportunity for partnered sex, gender and age, to examine their independent associations with perceived changes in sexual frequency and satisfaction.ResultsMost participants (86.7%) reported some form of sex following lockdown with physical activities more commonly reported than virtual activities (83.7% vs 52.6%). Altogether, 63.2% reported sex with someone (‘partnered sex’) since lockdown, three-quarters of whom were in steady cohabiting relationships. With decreasing relationship formality, partnered sex was less frequently reported, while masturbation, sex toy use and virtual activities were more frequently reported. Around half of all participants perceived no change in partnered sex frequency compared with the 3 months pre-lockdown, but this was only one-third among those not cohabiting, who were more likely to report increases in non-partnered activities than those cohabiting. Two-thirds of participants perceived no change in sexual satisfaction; declines were more common among those not cohabiting. Relationship informality and younger age were independently associated with perceiving change, often declines, in sexual frequency and satisfaction.ConclusionsOur quasi-representative study of the British population found a substantial minority reported significant shifts in sexual repertoires, frequency and satisfaction following the introduction of COVID-19 restrictions. However, these negative changes were perceived by some more than others; predominantly those not cohabiting and the young. As these groups are most likely to experience adverse sexual health, it is important to monitor behaviour as restrictions ease to understand the longer term consequences, including for health services.

Once perceived as a means for those unsuccessful at traditional dating, online dating has become normalized as a way to seek sexual or romantic partners. In 2019, we interviewed 40 British adults on the role of digital technologies in their sexual lives; this paper draws on the accounts of 22 who had used such technologies for seeking partners. We analyzed qualitative accounts of online partner seeking as a social practice, drawing on a sample diverse in age, gender and sexual orientation, and informed by sexual script and social practice theory. Our theoretically informed analysis emphasized the multiple meanings and goals involved, the affordances of the technology and individuals' skills. Our study provided several novel contributions. Young heterosexual people commonly used general social media, rather than dating apps, to meet partners; meeting partners often involved complex interplays between online and offline networks and encounters. Risks were defined not merely in relation to "risky others" but in terms of one's own actions or attitudes. Participants deployed various skills in minimizing harms such as non-consensual sharing of intimate images, and used self-care skills such as setting limits to engagement.

This study elicited views of key stakeholders on the need for adolescent sex eudcation and the appropriate model to adopt in Saudi Arabia. Semi-structured interviews were conducted in Riyadh, Saudi Arabia, with 28 stakeholders: policy-makers; social and healthcare providers; teachers and school staff; and religious scholars. Interviews were recorded and transcribed verbatim. Thematic analysis was conducted to identify emerging themes. Stakeholders saw the need to provide sex education. Opinions fell across a spectrum of model preference: abstinence-only or harm reduction. The conceptualisation of harm incorporated social risks. Silences and avoidance marked the boundaries between what was permitted and what was prohibited. In determining the form of any sex education curriculum in Saudi Arabia, caution is needed in assuming the ready transferability of Western-based models of sex education since in Saudi Arabia harm is conceptualised as damaging personal reputation, social structure and physical health. Religious doctrine and scientific evidence are perceived as non-conflicting sources for formulating a culturally sensitive programme. Local idiom characterised by indirectness and ambiguity offers challenges and possibilities for conveying sensitive messages. Findings from this study can be useful for communities with similar religious beliefs or social traditions intending to formulate an acceptable sex education programme.

Background: By regulating behaviour at household level, COVID-19 restrictions drastically altered relationships. Given strong links between intimate relationships and health, we investigated how the pandemic impacted relational and sexual aspects of steady relationships in Britain in the 4-months following first national lockdown (23/3/2020). Methods: 6,657 participants aged 18–59 years completed a web-panel survey questionnaire between 29/7–10/8/20. A quasi-representative population sample was achieved via quotas and weighting. We analysed sexual activity by age, gender and cohabitation status, and used descriptive statistics and logistic regression to explore self-perceived changes in sex and relationship quality among those in steady relationships (n=4,271). Results: Of the full sample, 64.2% were in a steady relationship, mostly cohabiting (88.8%). Following lockdown, 48.9% of those in cohabitating relationships and 36.4% in non-cohabiting relationships reported sex (anal/vaginal/oral) at least weekly. Frequency of sexual activity varied by age, gender and cohabitation status. The majority reported no change in their sex life and relational quality compared with the months pre-lockdown. Among those perceiving change, quality of sex life was more commonly reported to deteriorate, whereas quality of relationship was more commonly reported to improve. Change – both positive and negative – was more commonly reported by younger people. Overall, 7% reported deterioration to a ‘lower quality’ relationship, with deterioration more commonly reported by those: in mid-life (35–44 vs. 45–59) (men, AOR:2.31; 95%CI:1.45–3.66; women, AOR=1.63; 95%CI:1.03–2.56); living in an urban area (among men) (AOR:2.61; 95%CI:1.15–5.90); and not living with a partner (among women) (AOR:2.01; 95%CI:1.28–3.16). Deterioration was associated with poor health and with decline in sexual aspects of the relationship. Conclusion: COVID-19 led to an early net gain in relationship quality but net loss in quality of sex lives in steady relationships in UK. A sizeable minority of steady relationships were adversely affected with implications for sexual – and wider – wellbeing.

COVID-19 related restrictions have impacted the dynamics of romantic relationships, with many cohabiting partners spending more time together and non-cohabiting partners much less. We explored qualitatively, the vulnerabilities (characteristics that decreased resilience) and stressors that impacted intimate relationships following the initial COVID-19 lockdown. 45 semi-structured interviews were undertaken with participants who had completed a national web-panel survey (Natsal-COVID) and agreed to follow-up. Here we draw on the accounts of 19 participants in steady relationships who reported relationship difficulties. Analysis drew on Karney and Bradbury’s ‘Vulnerability-stress-adaptation’ model. The sample comprised 12 women and 7 men, 13 were living with their partner and 6 were not. Participant’s pre-existing attachment, coping, and communication styles shaped their susceptibility to relationship difficulties. The stress of COVID-19, amplified by financial strain and health issues, affected couple’s ability to adapt. In live-in relationships, childcare, divisions of housework, and a lack of space in which to unwind and escape from negative behaviours intensified pressures on relationship quality. One participant described these in the context of a violent relationship that worsened during lockdown, which she had managed to leave. Participants who did not live with their partners described struggling with phone/digital communication, physical distance, and a lack of certainty in the future of their relationship. In adapting to ‘pandemic life’, tensions arose over how much time to spend together. Those in non-cohabiting relationships were torn between balancing risks of COVID-19 against those of not seeing each other, with many reporting feeling they had placed their relationship on hold. For some, their sex life improved their adaptation, while for others it was a further source of stress. Understanding how existing vulnerabilities interact with a stressful event to shape adaptive processes in couples’ relationships might provide insights for counsellors and healthcare providers to better support couples through COVID-19.

Background: Rapid development and uptake of digital technologies have influenced sexual lives. As part of development research for the decennial British National Survey of Sexual Attitudes and Lifestyles (Natsal–4), we aimed to understand the practices of adults in Britain using digital technologies to meet sexual and romantic partners. Methods: We conducted 40 semi-structured interviews with adults in Britain on the role digital technologies played in their sexual lives. Here we draw on the accounts of 22 of those who had direct experience of online partner seeking. Informed by Social Practice Theory, we developed thematic codes encompassing the materials, skills and meanings that constitute online partner-seeking as a social practice. Findings: Online partner seeking is a social practice normalised in contemporary culture, enmeshed within broader online cultures of image presentation. It is associated with multiple goals and imbued with possibilities as well as risks. Material elements we identified related to the technology, its affordances, and how these shape interactions. We found that technological, interpersonal, and self-care skills were together required to seek and progress to various relationship forms and protect the self. Distinct linguistic, sexual, harm/damage limitation and exit strategies also drew on a range of skills. Participants reflected on how they presented themselves online, on their intentions, and on the skills required to ‘read’ situations and act authentically. Conclusion: While online partner seeking has often been considered individualistic, outcomes can be read through a lens of Social Practice Theory. Successful partner selection, communication and avoidance of harm depend on a complex learned constellation of the skills, materials and meanings associated with dating choices. Our findings have potential to inform survey questionnaire design and effective, nuanced health promotion interventions which consider intersecting dimensions of this social practice to build skills, develop goals and assess strategies to respond to unwanted interaction.

Background: Intimate relationships are ubiquitous and exert strong influence on health. Widespread disruption to them may impact wellbeing at a population level. We investigated the extent to which the first COVID-19 lockdown (March 2020) affected steady relationships in Britain. Methods: 6,654 participants aged 18-59 years completed a web-panel survey between 29/7-10/8/2020. Quasi-representativeness was achieved via quota sampling and weighting. We explored changes in sex life (5 dimensions) and relationship quality (6 dimensions) among participants in steady relationships (n=4,271) by age, gender, and cohabitation status, and examined factors associated with deterioration to a lower quality relationship. Results: 64.2% of participants were in a steady relationship, mostly cohabiting (88.8%). 22.1% perceived no change in their sex-life quality, and 59.5% no change in their relationship quality. Among those perceiving change, sex-life quality was more commonly reported to decrease and relationship quality to improve. There was significant variation by age, but less often by gender or cohabitation. Overall, 10.6% reported sexual difficulties that started or worsened during lockdown. 6.9% reported deterioration to a ‘lower quality’ relationship, more commonly those: aged 18-24 (women only OR 2.38;1·39-4·08) and aged 35-44 (women OR1.63;1.03-2.56, men OR 2.31;1.45-3.66) compared with those aged 45-59; not living with partner (women only aOR 2.01;1.28-3.16); and reporting depression/anxiety (e.g., depression (women aOR 2.56;1.79-3.64, men aOR 3.06;2.02–4.63). Interpretation: Intimate relationship quality is yet another way in which COVID-19 has led to divergence in experience, with age a key determinant of impact. Funding Information: Natsal (Wellcome Trust/ESRC/NIHR), MRC/CSO, UCL COVID-19 Rapid Response Fund. Declaration of Interests: The authors have no interests to declare. Ethics Approval Statement: Ethical approval was obtained from the University of Glasgow MVLS College (20019174) and LSHTM research ethics committees (22565).

Cyberbullying is associated with considerable negative mental and psychosocial consequences in children and young people, making it a serious public health concern. To review the highest level of available evidence, a systematic mapping review was conducted to identify systematic reviews that investigated the relationship between cyberbullying and mental and psychological outcomes in young people. Topic-relevant bibliographic databases and online resources were searched to identify reviews published since 2007. Data were extracted using a coding tool developed for this study. Methodological quality of included reviews was assessed using AMSTAR criteria. Nineteen systematic reviews satisfied the inclusion criteria and they reported a strong negative association between cyberbullying and mental health outcomes in young people. Meta-analysis was performed in 11 reviews and narrative synthesis in 8 reviews. Data were derived from predominantly cross-sectional studies and a clear causal relationship between cyberbullying and mental outcomes cannot be established. Two-third of the included reviews were classified to be of low or unclear quality, due to the lack of quality assessment of the primary studies included in individual reviews. This systematic map consolidates available evidence at review level and confirms the existing gaps in longitudinal and qualitative evidence synthesis. Closer examination of the moderating factors influencing cyberbullying behaviors in future research can advance our understanding and inform the development of tailored programs of intervention to mitigate the negative impact of this phenomenon.

Background: Physical distancing aims to reduce interactions between people to prevent SARS-CoV-2 transmission. Intimate physical contact outside the household (IPCOH) may expand transmission networks by connecting households. We explored whether intimacy needs impacted adherence to physical distancing following lockdown in Britain in March 2020. Methods: The Natsal-COVID web-panel survey (July-August 2020) used quota-sampling and weighting to achieve a quasi-representative population sample. We estimated IPCOH with a romantic/sexual partner in the four weeks prior to interview and identified associated factors. Qualitative interviews (n=18) were conducted to understand the context, reasons, and decision-making around IPCOH. Findings: Of 6,654 participants aged 18-59 years, 9.9% (95%CI:9.1-10.6%) reported IPCOH. IPCOH was highest in those aged 18-24 (17.7%), identifying as gay or lesbian (19.5%), and in steady non-cohabiting relationships (56.3%). IPCOH was associated with reporting risk behaviours (e.g., condomless sex, higher alcohol consumption). IPCOH was less likely among those reporting bad/very bad health (aOR 0.54;0.32-0.93) but more likely among those with COVID-19 symptoms and/or diagnosis (aOR 1.34;1.10-1.65). Two-thirds (64.4%) of IPCOH was reported as being within a support bubble. Qualitative interviews found that people reporting IPCOH deliberated over, and made efforts to mitigate, the risks. Interpretation: Given 90% of people did not report IPCOH, this contact may not be a large additional contributor to SARS-CoV-2 transmission, although heterogeneity exists within the population. Public health messages need to recognise how single people and partners living apart balance sexual intimacy and relationship needs with adherence to control measures. Funding Information: Natsal (Wellcome/ESRC/NIHR), MRC/CSO, and UCL COVID-19 Rapid Response Fund. Declaration of Interests: The other authors declare that they have no conflicts of interest. Ethics Approval Statement: Ethical approval was obtained from the University of Glasgow MVLS College (reference 20019174) and LSHTM research ethics committees (reference 22565). An anonymised dataset will be deposited with the UK Data Archive.

Background Accurate information on a nation’s sexual health is essential to plan and evaluate services, inform prevention, and contribute to societal understanding. In Britain, sexual health data arise from surveillance systems, convenience surveys of key populations, and the decennial National Surveys of Sexual Attitudes and Lifestyles (Natsal). Natsal has employed ‘gold-standard’ population survey methods: probability sampling, trained fieldworkers conducting detailed computer-assisted-personal-interviewing, and biosampling. However, this approach is resource-intensive and limitations include declining response rates and concerns about non-response bias. In designing Natsal-4, we reviewed whether alternative methods could meet the needs of data-users and the wider community. Methods We evaluated methods used by major UK general population surveys and sexual health surveys internationally. Key considerations were: general population representativeness; sample size; breadth and depth of information collected; data quality; biosampling; the possibility for sub-group ‘boost’ sampling, and data linkage. Results Five alternative methods were assessed (1) random-digit dialling phone surveys: considered unsuitable due to inadequate sample frame and response rate; (2) inviting participants from existing probability surveys to a follow-up sexual health interview: unsuitable because of additional non-response bias, difficulty achieving required sample size, and minimal cost-saving; (3) adding a sexual health module to existing probability survey(s), and (4) conducting a probability survey with fieldworker-selected individuals asked to self-complete a sexual health web-survey: both considered unsuitable due to much-reduced questionnaire; (5) ‘web-first’ mixed-mode survey, involving postal invitations to complete a web-survey with non-responding addresses followed-up by post and/or fieldworker visit: unsuitable due to concerns about response rate, unmeasurable and measurable response bias, and selection bias. Conclusion Given major drawbacks of the alternatives examined, the design used for previous waves of Natsal is still considered the best option for achieving a representative sample, enabling detailed data collection, enhancing survey data with biological and routine data, and retaining Natsal’s time-series; together maximising Natsal’s utility and impact. Disclosure No significant relationships.

We would like to follow up our 2014 publication in this journal by submitting further validation data to support the measurement of salivary testosterone (T), highlighting its independence from variations in circulating sex hormone-binding globulin (SHBG), unlike serum total T which is positively correlated with SHBG. All analyses were performed as previously described. In addition, further samples were collected from, 48 males and 38 females, healthy volunteers (mean age 32 y, range 18–66). Ethical committee approval was granted from Ghent University Hospital. These samples were analysed for salivary T, total T and equilibrium dialysis using liquid chromatography-tandem mass spectrometry. Figure 1 shows that: (i) serum total T is significantly and positively correlated with SHBG in both men (n1⁄4 93) and women (n1⁄4 86); (ii) serum calculated free T is not correlated with SHBG in men but negatively correlated with SHBG in women; (iii) salivary T is not correlated with SHBG in either men or women; (iv) serum-free T measured using equilibrium dialysis is not correlated with SHBG in men (n1⁄4 48) but, like calculated free T, is inversely correlated with SHBG in women (n1⁄4 38). These results demonstrate that salivary T is not influenced by variations in serum SHBG, unlike the analogue serum free T direct assay. The sexually dimorphic relationship between free T, whether calculated or measured by equilibrium dialysis, and SHBG, is an interesting observation which, to the best of our knowledge, has not been previously reported.

INTRODUCTION: To estimate the prevalence of use of different sources of contraceptive supplies in Britain and its variation by key demographic and behavioural characteristics. METHODS: Cross-sectional probability sample survey of women and men aged 16-74 years, resident in Britain, interviewed between 2010 and 2012. Analyses reported here were of 4571 women and 3142 men aged 16-44 years who reported having vaginal sex in the past year. Those relying exclusively on sterilisation (including hysterectomy) were excluded. Sources of contraceptive supplies were categorised as: general practice, community clinic, retail and other. Prevalence of use of these sources was estimated, and associated factors examined. RESULTS: Some 87.0% of women and 73.8% of men accessed at least one source of contraceptive supplies in the previous year. Most women (59.1%) used general practice and most men (54.6%) used retail outlets. Community clinics were less commonly used, by 23.0% of women and 21.3% of men, but these users were younger and at greater sexual health risk. These associations were also observed among the 27.3% of women and 30.6% of men who used more than one source category (general practice, community clinic or retail) for contraceptive supplies. CONCLUSIONS: People in Britain use a variety of sources to obtain contraceptive supplies and some sources are more commonly used by those more vulnerable to poorer sexual health. Our findings suggest that national policy changes to increase access to contraceptive methods have had an effect on the diversity of services used.

PURPOSE: To evaluate the uptake, feasibility and acceptability of a general practice-based optometrist-led glaucoma check service. The service targeted people of black Caribbean and black African descent aged 40-65 years, resident in Hackney, London, United Kingdom. METHODS: The study used a mixed-method design, including analysis of service data, prospective audit of secondary care referrals patient survey, cost-consequence analysis, and interviews with staff involved in developing and implementing the service. RESULTS: A total of 3040 patients were invited to undergo the free check; 595 (19.6%) booked an appointment and 461 (15.2%) attended. Overall, 31 patients (6.8%) were referred to secondary care, of whom 22 attended and were assessed for glaucoma. Four were diagnosed with glaucoma and eight with suspected glaucoma, i.e. 2.6% of patients who underwent the check. The cost per patient identified with suspected or confirmed glaucoma was £9,013. Staff who were interviewed suggested that patients who attended might be those who routinely attended optometrist appointments, however only 62.4% of survey respondents reported having had an eye examination in the previous two years, and 11.4% of women and 16.0% of men reported never having had an eye examination. CONCLUSION: This study represents one possible configuration for a glaucoma case-finding service, and it contributes to a wider debate about whether screening, targeted or otherwise, should be offered in the UK. Our findings suggest that general practice is an acceptable setting and that such a service may reach some people not previously engaged with primary eye care services.

Introduction: Measurement of salivary testosterone (Sal-T) to assess androgen status offers important potential advantages in epidemiological research. The utility of the method depends on the interpretation of the results against robustly determined population distributions, which are currently lacking. Aim: To determine age-specific Sal-T population distributions for men and women. Methods: Morning saliva samples were obtained from participants in the third National Survey of Sexual Attitudes and Lifestyles, a probability sample survey of the British general population. Sal-T was measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Linear and quantile regression analyses were used to determine the age-specific 2.5th and 97.5th percentiles for the general population (1675 men and 2453 women) and the population with health exclusions (1145 men and 1276 women). Results: In the general population, the mean Sal-T level in men decreased from 322.6 pmol/L at 18 years of age to 153.9 pmol/L at 69 years of age. In women, the decrease in the geometric mean Sal-T level was from 39.8 pmol/L at 18 years of age to 19.5 pmol/L at 74 years of age. The annual decrease varied with age, with an average of 1.0% to 1.4% in men and 1.3% to 1.5% in women. For women, the 2.5th percentile fell below the detection limit (, Précis: We studied the population distribution of salivary testosterone (Sal-T) levels using liquid chromatography-tandem mass spectrometry and found that the mean Sal-T level was approximately 6 times greater in men than in women and decreased with age in both sexes.

STUDY QUESTION: What is the prevalence of infertility and of help seeking among women and men in Britain? SUMMARY ANSWER: One in eight women and one in ten men aged 16-74 years had experienced infertility, defined by unsuccessfully attempting pregnancy for a year or longer, and little more than half of these people sought medical or professional help. WHAT IS KNOWN ALREADY: Estimates of infertility and help seeking in Britain vary widely and are not easily comparable because of different definitions and study populations. STUDY DESIGN, SIZE, DURATION: A cross-sectional population survey was conducted between 2010 and 2012 with a sample of 15 162 women and men aged 16-74 years. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants completed the Natsal-3 questionnaire, using computer-assisted personal interviewing (CAPI) and computer-assisted self-interview (CASI). MAIN RESULTS AND THE ROLE OF CHANCE: The reported prevalence of infertility was 12.5% (CI 95% 11.7-13.3) among women and 10.1% (CI 95% 9.2-11.1) among men. Increased prevalence was associated with later cohabitation with a partner, higher socio-economic status and, for those who had a child, becoming parents at older ages. The reported prevalence of help seeking was 57.3% (CI 95% 53.6-61.0) among women and 53.2% (CI 95% 48.1-58.1) among men. Help seekers were more likely to be better educated and in higher status occupations and, among those who had a child, to have become parents later in life. LIMITATIONS, REASONS FOR CAUTION: These data are cross-sectional so it is not possible to establish temporality or infer causality. Self-reported data may be subject to recall bias. WIDER IMPLICATIONS OF THE FINDINGS: The study provides estimates of infertility and help seeking in Britain and the results indicate that the prevalence of infertility is higher among those delaying parenthood. Those with higher educational qualifications and occupational status are more likely to consult with medical professionals for fertility problems than others and these inequalities in help seeking should be considered by clinical practice and public health. STUDY FUNDING/COMPETING INTERESTS: Funding was provided by grants from the Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health. AMJ is a Governor of the Wellcome Trust. Other authors have no competing interests.

Summary Background In 2000, a 10-year Teenage Pregnancy Strategy was launched in England to reduce conceptions in women younger than 18 years and social exclusion in young parents. We used routinely collected data and data from Britain's National Surveys of Sexual Attitudes and Lifestyles (Natsal) to examine progress towards these goals. Methods In this observational study, we used random-effects meta-regression to analyse the change in conception rates from 1994–98 to 2009–13 by top-tier local authorities in England, in relation to Teenage Pregnancy Strategy-related expenditure per head, socioeconomic deprivation, and region. Data from similar probability sample surveys: Natsal-1 (1990–91), Natsal-2 (1999–2001), and Natsal-3 (2010–12) were used to assess the prevalence of risk factors and their association with conception in women younger than 18 years in women aged 18–24 years; and the prevalence of participation in education, work, and training in young mothers. Findings Conception rates in women younger than 18 years declined steadily from their peak in 1996–98 and more rapidly from 2007 onwards. More deprived areas and those receiving greater Teenage Pregnancy Strategy-related investment had higher rates of conception in 1994–98 and had greater declines to 2009–13. Regression analyses assessing the association between Teenage Pregnancy Strategy funding and decline in conception rates in women younger than 18 years showed an estimated reduction in the conception rate of 11·4 conceptions (95% CI 9·6–13·2; p

PurposeThis paper aims to examine whether greater consideration should be given to the timing of sexual health interventions within the calendar year.Design/methodology/approachThe paper uses a review of the literature.FindingsThe evidence points to seasonality in a number of areas of sexual health among young people, including: the timing of first intercourse and conceptions, both of which peak in the summer and over Christmas; abortions which peak approximately two months later in February and late summer and sexually transmitted infections, which peak over the summer and autumn. In the case of conceptions there is evidence that the seasonal pattern among young people is different from that of adults. Potential explanations fall into four main categories: biological; behavioural; social, and service‐related.Research limitations/implicationsMany of the studies included in this review are from the USA, and some are based on either small samples or specific risk groups, which raises questions of representativeness and generalisability. Further, it is notable how little research there has been regarding seasonal variations in other aspects of sexual behaviour, such as risk reduction practice and other potential explanatory factors such as health‐seeking behaviour and availability of services.Practical implicationsThe findings consistently point to periods of heightened sexual activity among young people in the summer and over Christmas, and suggest that greater consideration should indeed be given to the timing of sexual health interventions within the calendar year.Originality/valueTo the best of the authors' knowledge, no other review of this kind has yet been found.

Establishing the clinical significance of symptoms of sexual dysfunction is challenging. To address this, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced two new morbidity criteria (duration and symptom severity) to the existing criteria of distress. This study sought to establish the impact of these three criteria on the population prevalence of sexual function problems. The data come from a national probability survey (Natsal-3) and are based on 11,509 male and female participants aged 16–74, reporting at least one sexual partner in the past year. The key outcomes were: proportion of individuals reporting proxy measures of DSM-5 problems, and the proportion of those meeting morbidity criteria. We found that among sexually active men, the prevalence of reporting one or more of four specific sexual problems was 38.2%, but 4.2% after applying the three morbidity criteria; corresponding figures for women reporting one or more of three specific sexual problems, were 22.8% and 3.6%. Just over a third of men and women reporting a problem meeting all three morbidity criteria had sought help in the last year. We conclude that the DSM-5 morbidity criteria impose a focus on clinically significant symptoms.

Objectives To describe the prevalence of medication use to assist sexual performance in Britain and to identify associated factors. Methods Cross-sectional probability sample, undertaken in 2010–2012, of 15 162 people aged 16–74 years, resident in Britain, of whom, 5617 men and 8095 women reported sexual experience (ever) and 4817 men were sexually-active (reported sex in the last year). Results Ever use of medication to assist sexual performance (medicated sex) was more commonly reported by men than women (12.9% (95% CI 11.9% to 13.9%) vs 1.9% (95% CI 1.7% to 2.3%)) and associated with older age in men and younger age in women. It was associated with reporting smoking, and use of alcohol and recreational drugs, as well as unsafe sex (≥2 partners and no condom use in the last year) in both men and women. Among men, the proportion reporting medicated sex in the last year was higher among those reporting erectile difficulties (ED) than those not doing so (28.4% (95% CI 24.4% to 32.8%) vs 4.1% (95% CI 3.4% to 4.9%)). In all men, medicated sex was associated with more frequent sexual activity, meeting a partner on the internet, unsafe sex and recent sexually transmitted infections diagnosis; associations that persisted after adjusting for same-sex behaviour and ED. However, there were significant interactions with reporting ED, indicating that among men with ED, medicated sex is not associated with same-sex behaviour and ever use of recreational drugs. Conclusions A substantial minority of people in Britain report medicated sex, and the association between medicated sex and risky sexual behaviour is not confined to high-risk groups.

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.

Objectives To examine variation in source of information about sexual matters by sociodemographic factors, and associations with sexual behaviours and outcomes. Design Cross-sectional probability sample survey. Setting British general population. Participants 3408 men and women, aged 17–24 years, interviewed from 2010–2012 for third National Survey of Sexual Attitudes and Lifestyles. Main outcome measures Main source of information (school, a parent, other); age and circumstances of first heterosexual intercourse; unsafe sex and distress about sex in past year; experience of sexually transmitted infection (STI) diagnoses, non-volitional sex or abortion (women only) ever. Results Citing school was associated with younger age, higher educational level and having lived with both parents. Citing a parent was associated, in women, with lower educational level and having lived with one parent. Relative to other sources, citing school was associated with older age at first sex (adjusted HR 0.73 (95% CI 0.65 to 0.83) men, 0.73 (0.65 to 0.82) women), lower likelihood of unsafe sex (adjusted OR 0.58 (0.44 to 0.77) men, 0.69 (0.52 to 0.91) women) and previous STI diagnosis (0.55 (0.33 to 0.91) men, 0.58 (0.43 to 0.80) women) and, in women, with lower likelihood of lack of sexual competence at first sex; and experience of non-volitional sex, abortion and distress about sex. Citing a parent was associated with lower likelihood of unsafe sex (0.53 (0.28 to 1.00) men; 0.69 (0.48 to 0.99) women) and, in women, previous STI diagnosis. Conclusions Gaining information mainly from school was associated with lower reporting of a range of negative sexual health outcomes, particularly among women. Gaining information mainly from a parent was associated with some of these, but fewer cited parents as a primary source. The findings emphasise the benefit of school and parents providing information about sexual matters and argue for a stronger focus on the needs of men.

Objectives: Our objective was to compare data on contraceptive use in relation to reported sexual activity in women from different minority ethnic groups.Design: We analyzed the National Survey of Sexual Attitudes and Lifestyles 2000.Subjects: Women aged 16-44 years, numbering 6932 and residing in Britain, participated in this study.Main Outcome Measures: Our main outcome measures are as follows: percentage of women reporting sexual activity, use of contraception and type of contraception (hormonal, barrier or permanent methods).Results: Overall, fewer women from the LTK's four main ethnic minority groups reported recent sexual activity, compared with white women. Among sexually active women, contraceptive use was significantly lower in all ethnic minority groups than in white women, but this pattern differed according to marital status. In ever-married or cohabiting women, lower contraceptive use was reported by Indian (78%) and Pakistani women (74%) than by other groups. Among single women, black Caribbean (88%) and black African (82%) women reported using less contraception compared with white (95%) and Indian (100%) women. Women from all ethnic minority groups were less likely than white women to report using hormonal contraception and permanent methods and were more likely to use barrier methods. The differences between ethnic groups remained significant after adjusting for educational achievement and parity. Deprivation and acculturation did not account for the use of contraception or the type of contraceptive method used.Conclusion: Sexually active married Pakistani and Indian women reported the lowest overall use of contraception. Among sexually active single women, black African and black Caribbean women reported levels of contraceptive use that were lower than those reported by white women. Sexually active women from all four minority ethnic groups were less likely than white women to use reliable methods of contraception. (c) 2006 Elsevier Inc. All rights reserved.

Purpose: To describe variations in age differences (ADs) between partners at first heterosexual intercourse and to examine associations between this AD, sociodemographic characteristics, and circumstances of first heterosexual intercourse, by gender.Methods: A total of 3277 men and 4734 women aged 25-44 years who reported ever having heterosexual intercourse in a probability survey of the British population to obtain an unbiased sample of ADs at first intercourse. Face-to-face interviews collected sociodemographic data and information on first intercourse. Gender-specific cumulative distributions of ADs categorized respondents reporting relatively younger first partners (below fifth percentile) and those reporting relatively older first partners (above 95th percentile).Results: Relatively older first partners were six years older than men and 10 years older than women. Relatively younger first partners were three years younger than men and one year younger than women. Men and women with relatively older first partners were more likely to have just met their partner (odds ratios adjusted for sociodemographic characteristics [AOR] 1.8, 95% confidence interval [CI] 1.2-2.7, and 3.1, 95% CI 2.1-4.6, respectively); had a more willing first partner (AOR 2.1, 95% CI 1.2-3.8, and 1.6, 95% CI 1.2-2.2, respectively); not used condoms at first sex (AOR 1.9, 95% CI 1.2-3.0, and 1. 5, 95% CI 1. 1-2.0, respectively); and reported a non-autonomous reason for first sex (AOR 1.6, 95% CI 1.1-2.4, women only). Men with relatively younger first partners were more likely to regret the timing of the first occasion (AOR 2.1, 95% CI 1.0-4.5).Conclusions: First partnerships involving relatively older or younger partners are associated with adverse circumstances of first intercourse. Condoms and other reliable contraception are less likely to be used, and age differences may reflect unequal power relations. Promoting effective communication and negotiation skills may be particularly important for those with relatively older or younger first partners. (c) 2006 Society for Adolescent Medicine. All rights reserved.

Objectives: To assess changes between 1990 and 2000 in the circumstances of women who became mothers before the age of 18. Design: Two cross sectional probability sample surveys of the general population carried out in 1989–1991 (Natsal 1990) and 1999–2001 (Natsal 2000). Setting: British households. Participants: Women aged 18 to 27 years at time of survey (Natsal 1990: 2575, Natsal 2000: 1757). Main outcome measures: Educational attainment, participation in education/work or training, living in social housing, social class, living as lone adult, parity, ill health, and health related behaviours at the time of the interview. Results: The proportion of women who were sexually active before 18 increased between 1990 and 2000 from 58.9% to 71.3% (p

Objective: To identify sociodemographic, sexual, and health behavioural and attitudinal factors associated with reporting sexual function problems. Methods: A probability sample survey of 11 161 men and women aged 16–44 years resident in Britain in 2000. Data collected by a combination of computer assisted face to face and self interviewing. Outcomes were self report of a range of sexual function problems, considered as “any problems” (1+ lasting 1+ months in the past year) and “persistent problems” (1+ lasting 6+ months in the past year), and associations with sociodemographic, behavioural, and attitudinal variables. Results: Both “any” and “persistent” sexual function problems were more commonly reported by women than men. A variety of sociodemographic factors were associated with both measures but differed by gender. For example, the adjusted odds ratio (AOR) for reporting any problems for married v single respondents was 0.70 (95% confidence interval (CI) 0.57 to 0.87) v 1.31 (95% CI 1.10 to 1.56) for men and women, respectively. Sexual behaviours significantly associated with reporting sexual function problems included competence at first sex, paying for sex in the past 5 years, number of occasions of sex and masturbation, both in the past 4 weeks. For men (only), reporting STI diagnosis(es) was significantly associated with reporting “any” problems (AOR 2.1, 95% CI 1.4 to 3.2) and “persistent” problems (AOR 2.1, 95% CI 1.1 to 3.9). Both measures were significantly more likely among men and women who reported communication difficulties with their partners, with AORs in excess of 1.9. Conclusions: Sexual fulfilment is an important part of sexual health. Understanding factors associated with reporting sexual problems, and recognising that such factors maybe partnership specific, is an important step towards improving our understanding of sexual function and thus improving the provision of care and support available.

BACKGROUND: We examined attendance at sexually transmitted disease (STD) clinics and the prevalence, distribution, and associated demographic and behavioral factors of self-reported sexually transmitted infections (STIs) in a population survey of sexual attitudes and lifestyles. METHODS: We analyzed data from stratified probability sample surveys obtained through the British National Surveys of Sexual Attitudes and Lifestyles (Natsal), which was undertaken in 1990 (n=13,765) and 2000 (n=11,161) among men and women aged 16-44 years. National STD surveillance data for 1999 were used to determine disease- and risk factor-specific proportionate population burden (PPB). RESULTS: Between 1990 and 2000, the number of subjects who reported having attended an STD clinic during the past 5 years increased from 4.3% to 7.6% among men and from 3.3% to 6.6% among women. In 2000, 3.0% of men and 4.0% of women reported having received a diagnosis of an STI during the past 5 years; 77.6% of men and 60.3% of women with an STI had attended an STD clinic. Reported STI acquisition was independently associated with age, increasing numbers of sex partners, male homosexual partners, and partners from abroad (for women only). Of all reported STIs during the past 5 years (PPB, 10.2%), 10.2% were reported by the 2.9% of men who reported having had homosexual partners during the past 5 years. Of all reported STIs in the past 5 years (PPB, 41.6%), 41.6% were reported by the 4.0% of women who reported having > or =10 sex partners during that time. Analysis of national STI surveillance data showed that the PPB for new episodes of Chlamydia trachomatis diagnosed among homosexual men was 2.8%, that for gonorrhea was 17.4%, and that for syphilis was 32.1%. CONCLUSIONS: Numbers and types of sexual partnerships remain the dominant individual and population risk factors for STI acquisition. Combined population behavior and surveillance data demonstrate the high PPB for STIs attributable to key risk factors. PPB may be a useful indicator of epidemic "phase" and may help target resources and guide prevention strategies.

Objectives: To estimate the prevalence and timing of homosexual experience among British men; to explore the patterns of sexual practices and partnerships in 2000, and behavioural and attitudinal changes between 1990 and 2000 among men who have sex with men (MSM).Design: Two large, stratified probability sample surveys of the general population.Methods: Trained interviewers administered a combination of face-to-face and self-completion questionnaires to men aged 16 to 44 years resident in Britain (n = 6000 in 1990 and n = 4762 in 2000).Results: in 2000, 2.8% of British men reported sex with men in the past 5 years. 46.0% of MSM reported five or more partners in the past 5 years, and 59.8% reported unprotected anal intercourse in the past year. A total of 33.0% of MSM reported one or more female partner(s) in the past year. In comparison with 1990, there was a significant increase in the proportion of MSM in the population in 2000, and among these men, in the proportion reporting receptive anal intercourse in the past year [age-adjusted odds ratio (OR), 2.08; 95% confidence interval (CI), 1.08-4.00], but no significant change in self-perceived HIV-risk (age-adjusted OR, 1.11; 95% Cl, 0.49-2.51) or HIV testing in past 5 years (age-adjusted OR, 1.14; 95% Cl, 0.57-2.25).Conclusions: Evidence of increasing prevalence of homosexual intercourse among the British male population coupled with increases in some HIV-risk behaviours among MSM suggests overall increasing numbers at risk in the population. Although these changes may partly reflect an increased willingness to report these behaviours, our results are consistent with increasing incidence of sexually transmitted infections and behavioural surveillance data. (C) 2004 Lippincott Williams Wilkins.

Background The need to improve the quality and availability of information on sexual health is identified as a key element in achieving the aims set out in the National Strategy for Sexual Health and HIV. Providing information about sexual health to young people poses particular challenges because of the sensitive nature of the issues and because of the difficulties that young people may face in sourcing information and asking questions of professionals. Objective To explore the views of young people attending sexual health services on several aspects of service delivery, including provision of information. Method Twenty-five in-depth qualitative interviews were conducted with a purposive sample of young people attending a range of different outlets for sexual health care. Results This research revealed important information about the ways in which the type, format, tone and design of health promotion materials and the methods used to impart information to young people has a strong impact on client satisfaction during visits to sexual health services. Conclusions Young people vary greatly in their needs for sexual health information in terms of level, extent and manner of provision. Passive acceptance of information should not be taken to indicate tacit satisfaction with level and complexity. Written information needs to be used in conjunction with face-to-face discussion. Effective provision of sexual health information impacts notably on client satisfaction. Pitched at the right level, sexual health information has considerable potential to enhance sexual health status.

Background Relatively high rates of teenage conception and sexually transmitted infection among young people in Britain have focused attention on early sexual behaviour and its determinants. We report the results of the second National Survey of Sexual Attitudes and Lifestyles (Natsal 2000).Methods We did a probability sample survey between 1999 and 2001, of men and women aged 16-44 years in Britain. Participants were interviewed using a combination of computer-assisted face-to-face and self-completion questionnaires, and asked questions regarding first heterosexual intercourse, communication about sex, pregnancy, and sexually transmitted infections (STIs).Findings We recruited 11 161 men and women to the survey (4762 men, 6399 women). The proportion of those aged 16-19 years at interview reporting first heterosexual intercourse at younger than 16 years was 30% for men and 26% for women; median age was 16 years. The proportion of women reporting first intercourse before 16 years increased up to, but not after, the mid-1990s. There has been a sustained increase in condom use and a decline in the proportion of men and women reporting no contraceptive use at first intercourse with decreasing age at interview. Among 16-24 year olds, non-use of contraception increased with declining age at first intercourse; reported by 18% of men and 22% of women aged 13-14 years at occurrence. Early age at first intercourse was significantly associated with pregnancy under 18 years, but not with occurrence of STIs. Low educational attainment was associated with motherhood before 18 years, but not abortion.Interpretation The increase in the proportion of women reporting first intercourse before age 16 years does not appear to have continued throughout the past decade. Only a small minority of teenagers have unprotected first intercourse, and early motherhood is more strongly associated with educational level than with family background. Factors mast strongly associated with risk behaviour and adverse outcomes have considerable potential for preventive intervention.

Summary Background Studies of the epidemiology of sexually transmitted infections (STI) are largely based on surveillance data. As part of a national survey of sexual attitudes and lifestyles (Natsal 2000) in Britain, we estimated the frequency of self-reported STIs, and the prevalence of urinary Chlamydia trachomatis infection. Methods We did a stratified probability sample survey of 11 161 men and women aged 16–44 years in Britain. Computer assisted self-interviews contained items on the nature and timing of previously diagnosed STIs. Half of all sexually experienced respondents aged 18–44 years were invited to provide a urine sample for ligase chain reaction testing for C trachomatis infection. Findings 10·8% of men and 12·6% of women reported ever having an STI, 3·6% of men and 4·1% of women reported ever being diagnosed with genital warts, and 1·4% of men and 3·1% of women reported previous infection with C trachomatis . 76% of men and 57% of women ever diagnosed with an STI had been to a GUM clinic. C trachomatis was found in 2·2% (95% CI 1·5–3·2) of men and 1·5% (95% CI 1·11–2·14) of women with age-specific prevalence being highest among men aged 25–34 (3·1%) and women aged 16–24 years (3·0%). Non-married status, age, and reporting partner concurrency or two or more sexual partners in the past year were independently associated with infection with C trachomatis . Interpretation We show substantial heterogeneity in distribution of reported STIs, and the demographic and behavioural determinants of prevalent genital chlamydial infection. The results have potentially wide application for proposed chlamydia screening programmes which, given the demonstrated prevalence, must now proactively seek to involve men.

Aims to show that audit and feedback could improve the prescribing of hormone replacement therapy (HRT) to women with a history of hysterectomy. Describes a randomised controlled trial involving 28 practices and covering a total of 3,169 women with a baseline coded history of hysterectomy. In addition to data extraction and feedback, intervention practices were given educational material and audit support. A rise in prescribing was evident in both younger and older women. There was also evidence of significant improvement in the appropriate prescribing of HRT. Concludes that prescribing feedback linked with educational material and audit can improve the prescribing of HRT in primary care in women with a history of hysterectomy and that this technique has wider application in the new era of clinical governance.

Broad spectrum approaches to health promotion, using mass media techniques to reach the general population, have potential value in raising the profile of health issues, providing legitimacy to efforts at community level and providing the impetus for other activities. Their cost‐effectiveness, however, is difficult to assess and has been questioned by some. This paper makes the case for a systematic approach to the evaluation of mass media health promotional interventions. Formative evaluation is needed to ensure the optimally effective design of such interventions, followed by process evaluation to identify factors which have enhanced or hindered implementation, followed by outcome evaluation, to assess the extent to which desired effects have been achieved, and adverse effects avoided. An eclectic approach to outcome evaluation is recommended including the use of experimental approaches wherever possible, but also ensuring that non‐experimental methods are rigorous and comprehensive. This review is aimed at practitioners using mass media interventions in health promotion as well as students of health promotion and its evaluation.

Background Data from the first two National Surveys of Sexual Attitudes and Lifestyles, carried out in 1990–1991 (Natsal-1) and 1999–2001 (Natsal-2), have been extensively used to inform sexual health policy in Britain over the past two decades. Natsal-3 was carried out from September 2010 to August 2012 in order to provide up-to-date measures of sexual lifestyles and to extend the scope of the previous studies by including an older age group (up to 74 years), an extended range of topics and biological measures. Methods We describe the methods used in Natsal-3, which surveyed the general population in Britain aged 16–74 years (with oversampling of younger adults aged 16–34 years). Results Overall, 15 162 interviews were completed, with a response rate of 57.7% and a cooperation rate of 65.8%. The response rate for the boost sample of ages 16–34 years was 64.8%, only marginally lower than the 65.4% achieved for Natsal-2, which surveyed a similar age range (16–44). The data were weighted by age, gender and region to reduce possible bias. Comparisons with census data show the weighted sample to provide good representation on a range of respondent characteristics. The interview involved a combination of face-to-face and self-completion components, both carried out on computer. Urine samples from 4550 sexually-experienced participants aged 16–44 years were tested for a range of STIs. Saliva samples from 4128 participants aged 18–74 years were tested for testosterone. Conclusions Natsal-3 provides a high quality dataset that can be used to examine trends in sexual attitudes and behaviours over the past 20 years.

Background Salivary testosterone (Sal-T) may be a useful surrogate of serum free testosterone. The study aims were to use a novel liquid chromatography tandem mass spectrometry (LC-MS/MS) assay to determine whether Sal-T concentrations accurately reflect Sal-T concentrations in both sexes and to investigate practical aspects of sample collection. Methods Saliva and serum samples were collected in 104 male and 91 female subjects. A more sensitive LC-MS/MS assay was developed to enable Sal-T quantitation in the low concentrations found in females. Saliva (200 µL) was extracted with 1 mL of methyl- tert-butyl ether following the addition of D5-testosterone. Quantitation was performed using a Waters TQ-S mass spectrometer. Results The assay achieved a lower limit of quantification of 5 pmol/L, sufficiently sensitive to measure testosterone in female saliva. Sal-T showed a diurnal variation but samples taken at weekly and monthly intervals showed no significant differences. Sal-T was stable at ambient temperature for up to 5 days, after freeze-thawing and 3 years frozen storage. Reference intervals for Sal-T were 93–378 pmol/L in males and 5–46 pmol/L in females. Sal-T correlated significantly with serum calculated free-T in males ( r = 0.71, P Conclusions These results confirm that testosterone can be reliably and accurately measured by LC-MS/MS in both adult male and female saliva samples. These results lay the foundation for further exploration of the clinical application of Sal- T as a reliable alternative to serum testosterone in the diagnosis and management of androgen disorders and assessment of androgen status in clinical research.

Background/introduction Sexual function is largely absent from the policy discourse on young people’s sexual health. The omission is troubling, given the link between low sexual function and indicators of risk (including higher partner numbers, paying for sex, non-consensual sex and STI diagnosis). An absence of data permits this silence. Aim(s)/objectives To address the gap in empirical data on sexual function problems in young people aged 16 to 21 in Britain. Methods Descriptive statistics from a national probability survey of 15,162 British men and women (Natsal-3), undertaken from 2010–2012 using computer-assisted self-interviews (CASI). Complex survey analyses of data from participants aged 16–21 (854 men and 1021 women sexually active in the last year; 262 men and 255 women sexually experienced but not active in the last year). Results Distressing sexual function problems (>3months in last year) were reported by 9.1% of men and 13.4% of women. Most common among men was reaching a climax too quickly (4.5%) and among women, difficulty reaching climax at all (6.3%). The majority of young people experiencing problems did not seek help, and those that did rarely sought out professionals. Around 6% of those currently sexually active, and 10% of those not so, reported avoiding sex because of sexual function problems. Discussion/conclusion Sexual function problems are common among young people and are largely unaddressed. Addressing these clear needs will have benefits for other aspects of sexual health. Reassurance in clinical settings and information/advice in educational settings are inexpensive and potentially effective strategies.