Abstract

SummaryBackgroundSexual behaviour and relationships are key components of wellbeing and are affected by social norms, attitudes, and health. We present data on sexual behaviours and attitudes in Britain (England, Scotland, and Wales) from the three National Surveys of Sexual Attitudes and Lifestyles (Natsal).MethodsWe used a multistage, clustered, and stratified probability sample design. Within each of the 1727 sampled postcode sectors for Natsal-3, 30 or 36 addresses were randomly selected and then assigned to interviewers. To oversample individuals aged 16–34 years, we randomly allocated addresses to either the core sample (in which individuals aged 16–74 years were eligible) or the boost sample (in which only individuals aged 16–34 years were eligible). Interviewers visited all sampled addresses between Sept 6, 2010, and Aug 31, 2012, and randomly selected one eligible individual from each household to be invited to participate. Participants completed the survey in their own homes through computer-assisted face-to-face interviews and self-interview. We analysed data from this survey, weighted to account for unequal selection probabilities and non-response to correct for differences in sex, age group, and region according to 2011 Census figures. We then compared data from participants aged 16–44 years from Natsal-1 (1990–91), Natsal-2 (1999–2001), and Natsal-3.FindingsInterviews were completed with 15 162 participants (6293 men, 8869 women) from 26 274 eligible addresses (57·7%). 82·1% (95% CI 81·0–83·1%) of men and 77·7% (76·7–78·7%) of women reported at least one sexual partner of the opposite sex in the past year. The proportion generally decreased with age, as did the range of sexual practices with partners of the opposite sex, especially in women. The increased sexual activity and diversity reported in Natsal-2 in individuals aged 16–44 years when compared with Natsal-1 has generally been sustained in Natsal-3, but in men has generally not risen further. However, in women, the number of male sexual partners over the lifetime (age-adjusted odds ratio 1·18, 95% CI 1·08–1·28), proportion reporting ever having had a sexual experience with genital contact with another woman (1·69, 1·43–2·00), and proportion reporting at least one female sexual partner in the past 5 years (2·00, 1·59–2·51) increased in Natsal-3 compared with Natsal-2. While reported number of occasions of heterosexual intercourse in the past 4 weeks had reduced since Natsal-2, we recorded an expansion of heterosexual repertoires—particularly in oral and anal sex—over time. Acceptance of same-sex partnerships and intolerance of non-exclusivity in marriage increased in men and women in Natsal-3.InterpretationSexual lifestyles in Britain have changed substantially in the past 60 years, with changes in behaviour seeming greater in women than men. The continuation of sexual activity into later life—albeit reduced in range and frequency—emphasises that attention to sexual health and wellbeing is needed throughout the life course.FundingGrants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health.

Highlights

  • Improving sexual and reproductive health remains a public health priority in Britain (England, Scotland, and Wales),[1] as it does globally.[2]

  • People younger than 25 years are at highest risk for some adverse sexual health outcomes, such as sexually transmitted infections[4] and unplanned pregnancies.[5]

  • We have presented findings from National Surveys of Sexual Attitudes and Lifestyles (Natsal)-3 on sexual attitudes and lifestyles in Britain in 2010–12

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Summary

Introduction

Improving sexual and reproductive health remains a public health priority in Britain (England, Scotland, and Wales),[1] as it does globally.[2]. The first National Survey of Sexual Attitudes and Lifestyles (Natsal-1) was done in a probability sample of 18 876 adults aged 16–59 years in Britain in 1990–91.9,10 It provided urgently needed population-based data to inform the prevention and prediction of HIV transmission.[9,10] A second survey (Natsal-2) of 11 161 adults aged 16–44 years in 1999–2001 extended the investigative focus to broader aspects of sexual and reproductive health.[11,12,13,14] Data from these surveys have been widely used to inform sexual and reproductive health policy in Britain.[15,16,17,18,19]

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