Web-Based Initiatives to Prevent Sexual Offense Perpetration: A Systematic Review.

PURPOSE OF REVIEW: Web-based programs to prevent sexual offense perpetration could provide an opportunity that avoids many of the barriers associated with in-person treatment. The aim of this systematic review is to give an overview of the literature on web-based initiatives aimed at sexual offense perpetration prevention published during the last 10 years (2013-2023) and to report data on the efficacy as well as issues of the discussed initiatives. RECENT FINDINGS: We included 18 empirical studies discussing web-based perpetration prevention initiatives, of which six are randomized controlled trials. Among the articles, four cover programs focusing on prevention of sexual reoffending and 14 discuss programs aimed at preventing initial sexual offenses. Evaluations and observations of web-based initiatives aimed at preventing sexual offense perpetration show overall promising results and are well-appreciated. However, evaluation studies are scarce and more randomized controlled trials replicating this effect are warranted.

Living without Partnered Sex in Germany. Results From the First Representative, Population-based German Health and Sexuality Survey (GeSiD).

Broader insights into the life situations of sexually inactive adults in Germany are widely unexplored. Within the nationally-representative survey GeSiD (German Health and Sexuality Survey), undertaken 2018-2019, data of 4,758 participants with lifetime interpersonal sexual experience aged 18-75 years (men: n = 2234; women: n = 2524) were analyzed in regards to partnered sexual inactivity in the past 12 months (PSI; no genital-involving sexual contact with another person). Overall, advanced age, being single and impaired health conditions were associated with PSI. Data showed gender-specific associations with PSI, such as less alcohol, smoking and drug use in women. PSI was associated with lower general life satisfaction throughout different age groups.

Single and Multiple Orgasm Experience Among Women in Heterosexual Partnerships. Results of the German Health and Sexuality Survey (GeSiD).

BACKGROUND: Orgasm occurrence plays an important role in general sexual satisfaction for women. Until now, only few studies have focused on examining a broad spectrum of sexuality- and relationship-specific factors associated with orgasm in heterosexual women currently in a long-term relationship or on differences between the overall experience of orgasm and multiple orgasms. AIM: The present study aims to understand how various sexuality- and relationship-associated factors are related to experiencing partnered orgasm among heterosexual women having stable relationships in Germany. Moreover, the study aims to differentiate between the overall experience of orgasm and the experience of multiple orgasms and shed light on their impact on general sexual satisfaction. METHODS: Within the nationwide representative survey GeSiD (German Health and Sexuality Survey), n = 1,641 sexually active women aged between 18 and 75 years in heterosexual relationships reported their experience of orgasm during the latest sexual encounter. Data on the type of sexual practices, frequency of sexual activity and of masturbation, relationship satisfaction, feelings of love, closeness, and general sexual satisfaction were analyzed. OUTCOMES: The overall experience of orgasm, the experience of multiple orgasms, and associations between experiencing orgasm and sexual satisfaction. RESULTS: Frequency of sexual activity, relationship satisfaction, feelings of love and closeness were moderately to strongly positively correlated with each other and each showed positive associations with the likelihood of orgasm. Greater number of sexual practices and frequency of sexual activity were associated with an increased likelihood of experiencing multiple orgasms, which in turn was correlated with higher sexual satisfaction. CLINICAL IMPLICATIONS: In clinical and therapeutic work with women who have difficulty achieving orgasm, central issues should be the perceived relationship quality as well as regular sexual activity with the partner. STRENGTHS & LIMITATIONS: The present population-representative study is the first in Germany to identify significant factors associated with the experience of orgasm among heterosexual women in relationships. Further studies ought to include the frequency of orgasms in partnered sex over a longer period of time as well as the experience of orgasm during masturbation. CONCLUSION: The experience of orgasm for women is related to a variety of complex interpersonal mechanisms and to be associated with sexual satisfaction. Cerwenka S, Dekker A, Pietras L, et al. Single and Multiple Orgasm Experience Among Women in Heterosexual Partnerships. Results of the German Health and Sexuality Survey (GeSiD). J Sex Med 2021;18:2028-2038.

[Non-consensual forwarding of personal erotic photos at schools : A survey of school principals in Schleswig-Holstein on sexual border violations using digital media]. / Zur nichtkonsensuellen Weiterleitung persönlicher erotischer Fotos an Schulen : Eine Befragung von Schulleitungen in Schleswig-Holstein zu sexuellen Grenzverletzungen mittels digitaler Medien.

BACKGROUND: The Internet and digital media entail both risks and opportunities for children and young people. One risk is posed by cases in which personal erotic photos of schoolchildren are forwarded against their will. For the children and adolescents concerned, the psychosocial consequences can be serious. OBJECTIVE: The aim of this study is to investigate the prevalence and consequences of non-consensual forwarding of personal erotic photos among children and adolescents at schools in the German state of Schleswig-Holstein. METHODS: From 25 April to 7 June 2019, principals of secondary schools were surveyed via an online brief questionnaire about both the incidence of non-consensual forwarding of erotic photos at their respective schools, as well as actions taken, consequences for the students depicted, and consequences for those who sent the photos. Information from 74 school administrators was included in the data analysis. RESULTS: In more than two-thirds of the schools, school principals were aware of at least one case of non-consensual forwarding of personal erotic photos. Measures taken were mostly informing the parents of all involved and a "guided exchange" between the involved students. The consequences for the affected students were reported to be social withdrawal, psychological suffering, school performance problems, and experiences with cyberbullying. In eight cases, affected students left the school. DISCUSSION: Non-consensual forwarding of personal erotic photos in schools is a problem of considerable magnitude. Up-to-date specific prevention measures are urgently needed.

[Lifetime prevalences of nonconsensual sexual intercourse and touch and associations with health-related factors : Results from the German Health and Sexuality Survey (GeSiD)]. / Lebenszeitprävalenz des Erlebens von Sex und sexueller Berührung gegen den eigenen Willen sowie Zusammenhänge mit gesundheitsbezogenen Faktoren : Ergebnisse aus der Studie Gesundheit und Sexualität in Deutschland (GeSiD).

BACKGROUND: In the last decade, the negative effects of sexual violence on health have again become a focus of health policies worldwide. So far, representative population data on lifetime prevalence for different age groups and specific links to health-related factors for Germany are lacking. OBJECTIVES: The study aimed to assess 1) the lifetime prevalence of self-reported nonconsensual sexual intercourse and sexual touch in childhood and across the lifespan and 2) associations with health-related factors. MATERIALS AND METHODS: Using a two-step stratified, randomized sample of residents' registration offices, 4955 persons aged 18 to 75 years were interviewed within the scope of the nationwide scientific survey on health and sexuality in Germany (GeSiD). The associations between experiences of sexual violence and socio-demographic and health-related factors were age-adjusted and stratified for gender using logistic regression. RESULTS: For women, the lifetime prevalence of (attempted/completed) nonconsensual intercourse was 14.9% and in the form of (attempted/completed) nonconsensual sexual touching was 40.8%; for men the prevalences were 3.1% and 13.2%, respectively. Regarding forced experiences in childhood, the prevalence of sex was 2.1% and of sexual touching was 7.5%. For both genders, the prevalence of nonconsensual intercourse was significantly higher in the case of low quality of life, poor health condition, a chronic illness or disability, or treatment for depression or for another mental disorder. CONCLUSIONS: The results illustrate the strong links between sexual violence and mental and somatic health. This points to the urgency to routinely explore experiences of sexual aggression.

[The German health and sexuality survey (GeSiD)-a brief introduction to the study]. / Die GeSiD-Studie "Gesundheit und Sexualität in Deutschland" ­ eine kurze Einführung.

Until 2020, there was no representative sex survey for Germany with published data. The GeSiD study "Health and Sexuality in Germany" is the first nationwide, representative sex survey. The aim of this paper is to provide a brief introduction to the German health and sexuality (GeSiD) survey.A total of 4955 persons (2336 men, 2619 women) aged 18-75 years were interviewed between 2018 and 2019. The computer-assisted face-to-face interviews had an extensive self-completion section and asked about a wide range of sexual behaviour and sexual health topics. Data on sexual identity, relationships, sexual behaviour, and sexual health were assessed. Data show, among other things, that only a minority of respondents had ever talked to a healthcare provider about HIV/AIDS or other sexually transmitted infections (STIs).Data show a clear need for education, information dissemination, and training in the area of sexual health.

[How good is the knowledge about sexually transmitted infections in Germany? : Results of the first nationwide representative German health and sexuality survey (GeSiD)]. / Wie gut ist das Wissen über sexuell übertragbare Infektionen in Deutschland? : Ergebnisse der ersten bundesweiten repräsentativen Befragung zu Gesundheit und Sexualität (GeSiD).

BACKGROUND: Sexually transmitted infections (STIs) are a relevant risk factor for the sexual health of individuals and the population. Therefore, the level of awareness and knowledge about STIs in different population groups is of particular interest for specific prevention work. OBJECTIVES: The aim of this study was to analyze the awareness of and knowledge about nine STIs in the German population. To do so, the study examined correlations with sociodemographic variables, sexuality-related characteristics, and subjective satisfaction with the level of information. METHODS: The GeSiD study "German Health and Sexuality Survey" collected representative quantitative data from 4955 persons via face-to-face interviews on the state of knowledge about STIs. As a selection procedure, a two-step random sample was collected. Firstly, 200 sample points (municipalities) were initially selected proportionally across Germany. Secondly, a random sample of addresses was drawn from the respective residents' registration offices. The participation rate was 30.2%; the average age was 46.3 years. RESULTS: Knowledge about HIV/AIDS was widespread in all age groups, but other STIs were significantly less known. Older people and respondents with a low level of education were particularly poorly informed. Local social disadvantage and a family history of migration were also negatively correlated with knowledge about STIs. A higher number of sexual partners is related to a better level of knowledge. In addition, persons who do not describe their sexual orientation as heterosexual as well as those with a history of STIs were well informed. CONCLUSION: Heterosexual adults in Germany are insufficiently informed about the risks of STIs. Therefore, target-group-specific efforts are needed to improve knowledge about STIs in order to reduce sexual risk behavior and improve the utilization of prevention programs among socially disadvantaged groups.

[Heterosexual Practices in Different Generations - Findings of a Pilot Study for "GeSiD Gesundheit und Sexualität in Deutschland (Health and Sexuality in Germany)"]. / Heterosexuelle Praktiken in unterschiedlichen Generationen ­ Ergebnisse einer Pilotstudie zu "GeSiD Gesundheit und Sexualität in Deutschland".

OBJECTIVES: There is a lack of broad representative data in Germany in order to analyze the lifetime experiences of heterosexual adults with different sexual practices. Differences between generations were investigated with regard to whether specific sexual experiences were more common in the generation aged from 18 to 30 years (the Digital Natives) than in the older generations, particularly referring to the generation of the 61- to 75-year-olds, whose sexual socialization was not yet embedded into the presence of new media. For young adults it was analyzed to what extent diversifications of the sexual repertoire can be depicted. METHODS: In a pilot-study (2) for GeSiD - Gesundheit und Sexualität in Deutschland (Health and Sexuality in Germany) - in 2017, a representative survey was carried out on 1155 persons aged from 18 to 75 years. Data from heterosexual men and women regarding lifetime experiences with different sexual practices and sexuality-related experiences were analyzed. RESULTS: In the generation of the 18 to 30 year olds, experiences with oral practices and the use of a dildo/vibrator were more common in women as well as sadomasochistic/BDSM-practices in both women and men compared with older generations. While in women there were hardly any differences between the 18 to 25 year olds and the 26 to 30 year olds, a higher percentage of young men revealed having not made a variety of sexual experiences. Oral practices, active anal stimulation and sexual role play were reported slightly more often by 26 to 30 year old men than by older ones. In the generation of the 61 to 75 year olds, experiences with oral and manual practices were reported less commonly by women as well as anal practices and the use of a dildo/vibrator by women and men in comparison with younger generations. DISCUSSION: The ongoing process of digital revolution at the end of the 20th century induced a fundamental societal change, which is also reflected in different ranges of sexual experiences in the generations. CONCLUSION: The results allow first insights into heterosexual practices among different generations in Germany that may provide valuable clues for the steering of information and education campaigns as well as a psychoeducational basis for couple and sex therapy work.

Pornographic Content and Real-Life Sexual Experiences: Findings From a Survey of German University Students.

The aim of this study was to explore liked pornographic content and real-life experience with the depicted sexual activities in a nationwide sample of 1,197 German university students. The results indicate that there is a positive, content-specific association. Generally, the link was stronger for less conventional (less widespread) practices. However, a considerable proportion of participants had no interest to experience activities they liked in pornography and this was especially the case for the unconventional activities. This indicates that pornography use may constitute a distinct form of sexuality and may create an "intimate space" for sexual fantasies.

Online sexual activity involving webcams-An overview of existing literature and implications for sexual boundary violations of children and adolescents.

Despite the relevance of the Internet and its increasing use for sexual purposes, research into online sexual activity (OSA) involving webcams is limited. Aside from positive experiences, OSA may implicate violations of sexual boundaries, reaching from minor issues to serious forms of sexual abuse. To provide a basis for a classification of sexual boundary violations online and a conceptualization of preventive measures, a systematic review of the literature on OSA involving webcams was conducted, resulting in publications from four thematic categories: webcam use in common OSA, psychopathological phenomena, sex work, and crime and indecency (commercial sexual exploitation, trafficking, and sexual boundary violations). The discussion addresses the implications of different types of sexual boundary violation of children and adolescents on the Internet. The study's Internet findings could promote prevention and law enforcement strategies tailored to these types of offense as well as different target groups.

[Sexting as a risk? : On consensual and non-consensual distribution of personal erotic pictures using digital media]. / Sexting als Risiko? : Zum konsensuellen und nichtkonsensuellen Versand persönlicher erotischer Fotos mittels digitaler Medien.

BACKGROUND: Digital media are used for the purpose of various sexual experiences. In recent years the exchange of erotic text messages or images ("sexting") has gained the attention of academic research and has increasingly been the center of public discussion on sexual boundary violations and violence via digital media. The unwanted forwarding of images to a third party is especially relevant in this respect. In contrast to media reports about sexting as a risk behavior with serious consequences, there is little empirical analysis about the actual sexting practice of adolescents and adults in Germany. OBJECTIVE: This paper is the first to describe sexting behavior of young adults in Germany on the basis of a large representative student sample. MATERIAL AND METHODS: Data were collected in 2012 in the course of a nationwide study. Students from 15 universities were asked among other things about their experiences with sending erotic text messages or images, the non-consensual forwarding of images and its consequences. RESULTS: More than half of the student sample reported sending erotic text messages, 26.8% of women and 16.8% of men had sent erotic images to someone, in most cases to their partner. Of the sexters, 2% mentioned that their images had been forwarded to another person without their consent. CONCLUSION: The results indicate that in Germany sexting is mostly practiced in the context of a romantic relationship. Only a small percentage experience unwanted forwarding of images, and negative consequences are not reported for all incidents; however, this does not relativize the impact of those events implicating serious negative consequences for the involved person.

[Sex education and prevention of sexual violence : Contributions to a differential-sensitive prevention of sexualised violence]. / Sexualpädagogik und Gewaltprävention : Beiträge zu einer differenzsensiblen Prävention von sexualisierter Gewalt.

Prevention of sexual violence against children and adolescents obtains high priority in educational contexts. This is due to the massive (possible) psychosocial impacts of sexual victimization as well as to the considerable prevalence rates that are reported in current studies. Preventive approaches are predominantly native to violence prevention and sex education where they are characterized by independent lines of tradition and positions. This contribution outlines their empirically largely unexplained relation with a focus on the history and development of the discourses of sex education. Diverging disciplinary attempts of positioning towards the prevention of sexual violence reveal an area of conflict between sex-positive and preventive educational objectives. A primacy of preventive contents is seen to be threatening a comprehensive sex education that emphasizes the positive aspects of sexuality. On the other hand, its standards are opposed to excluding and to tabooing sexual violence as a topic. Yet unfinished is therefore the search for a "third way" that might transfer the opposites of both approaches into integrative educational concepts. Unsettled questions about possible contributions of sex education to the prevention of sexual violence, and especially to which extent they are sensitive to difference are discussed based on international research and the theory of sex education.

[Sex survey research in Germany and Europe : Liebesleben (LoveLives): A pilot study into the sexual experiences, attitudes and relationships of adults in Germany]. / Sexsurveyforschung in Deutschland und Europa : Die Studie Liebesleben: Pilotstudie zu sexuellen Erfahrungen, Einstellungen und Beziehungen von Erwachsenen in Deutschland.

At the Hamburg Institute for Sex Research in Germany, a nationwide study is currently being carried out into the sexual experiences, attitudes and relationships of adults (18-75 years). The main focus of this pilot study is to test the comprehensibility and length of a data collecting instrument as well as the comparison of two data collecting methods with regard to reliability and representativeness of the results as well as of the refusal rate. To this end face-to-face interviews (n = 500) and questionnaires sent by post (n = 500) are to be compared with each other as methods. The data to be collected relates to sexuality, particularly the prevention of HIV and other sexually transmitted infections (STIs). The WHO definition of sexual health forms the basis for the study and thus connects up with the existing sex survey research in Europe and western industrial nations. Comparable surveys have been conducted over the past ten years in more than 30 European countries using a variety of methods. The focus of the study is placed upon the increase that has been observed for several years now in certain STIs. The article provides an overview of existing sex survey research in Europe. It becomes clear that the studies conducted so far are very heterogeneous with regard to chosen method, sampling techniques and the choice of content focus, so that no suitable data for cross-national comparability are currently available.

Pornography Use and Sexual Behavior Among Polish and German University Students.

The purpose of this study was to explore the relationship between pornography use and sexual behavior in young adults from two culturally different countries. Data were collected in an online survey among German (n = 1,303; G) and Polish (n = 1,135; P) university students aged 18 to 26 years. Pornography use was associated with engaging in a greater variety of sexual activities (e.g., sexual role playing, using sex toys; G > P) rather than with a high number of sex partners or condom use consistency. The differences between the samples were found primarily for females (in anal sex experience and age at the first sexual intercourse; G > P).

Sexual orientation of trans adults is not linked to outcome of transition-related health care, but worth asking.

Since the beginning of contemporary transition-related care at the outset of the 20th century, sexual orientation has ben considered to be closely connected with gender identity and the developmental trajectories of trans people. Specifically, health professionals have regarded the anticipated post-transitional heterosexual behaviour of trans adults as predictive of a good outcome of cross-sex hormones and gender-confirming surgeries. This article reviews the current literature according to the question of whether the sexual orientation of trans people is linked to outcome measures following transition-related interventions. A comprehensive review was undertaken using the Medline database, searching for empirical studies published between 2010 and 2015. Out of a total of 474 studies, only 10 studies reported a follow-up of trans adults and assessed sexual orientation in the study protocol at all. Sexual orientation was predominantly assessed as homosexual versus non-homosexual related to sex assigned at birth. Only one 1 of 10 follow-up studies found a significant association according to the outcome between groups differentiated by sexual orientation. Empirically there is no link between sexual orientation and outcome of transition-related health care for trans adults. In order to provide comprehensive health care, we recommend asking for sexual behaviours, attractions and identities, as well as for gender experiences and expressions; however, this knowledge should not drive, but simply inform, such comprehensive care.

Research in brief: How prevalent is rough sex? Results from a national online sample of adults in Germany.

BACKGROUND: Rough sex refers to consensual sexual activities that incorporate playful aggression, such as hair pulling, spanking, or choking. It is relevant in the context of sexual health as it can enhance sexual arousal, pleasure, and intimacy among consenting partners. However, it can also be associated with consent violations, discomfort, and injuries ranging from mild to severe or even fatal. The prevalence of rough sex in Germany is widely unknown. Our study aims to establish, for the first time, the overall age-related and gender-related prevalence rates of active and passive rough sex involvement among adults in Germany. METHODS: A national online sample of 1101 adults from Germany, aged 18-69 years (50% men, 49% women, 1% gender-diverse individuals) gave informed consent and reported on their lifetime engagement in rough sex in active and passive roles. We recruited participants through a professional panel provider for a multi-themed sexual health survey. Data analysis was conducted using R, with 95% confidence intervals of prevalence rates computed to answer the research questions. RESULTS: Lifetime prevalence of rough sex involvement was 29%. Adults below the age of 40 reported higher rates of involvement (up to 43%) than people over 40 (up to 26%). Men reported predominantly active role involvement and women reported primarily passive role involvement. DISCUSSION: Results show that rough sex is common. Sexual health professionals, educators, and researchers should be prepared to guide current and aspiring practitioners of rough sex, helping them understand potential benefits, risks, and age- and gender-related differences.

Genital abnormalities in early childhood in sexual homicide perpetrators.

INTRODUCTION.: The present study investigates the relevance of genital abnormalities (GA) like cryptorchidism, hypospadias, and phimosis usually diagnosed in early childhood for the development of psychosexual problems and deficits in a sample of N = 163 convicted sexual homicide perpetrators. AIMS.: The first aim was to investigate the prevalence of early childhood GA in a sample of sexual homicide perpetrators. The second was to explore differences in the psychosexual development of participants with GA in early childhood compared with those without GA. It was expected that offenders with GA show specific problems in their psychosexual development compared with offenders without GA. METHODS.: The data for the present study were obtained by reanalyzing an existing database derived from a large-scale research project about sexual homicide. Using a predominantly exploratory design we, therefore, divided the total sample into two subgroups (with vs. without indicators of GA). MAIN OUTCOME MEASURES.: Main outcome measures were the number of sexual homicide perpetrators showing GA in early childhood and the differences of subjects with and without GA with regard to their psychosexual development (i.e., according to sexual deviant interests or sexual dysfunctions). RESULTS.: The prevalence of GA is substantially higher in this sample than epidemiological studies indicated in the normal population. This result provided first support for the importance of GA in the population of sexual homicide perpetrators. Further analyses indicate significant differences between both subgroups: Offenders with GA in early childhood showed indicators for more sexual dysfunctions (e.g., erectile dysfunction) in adulthood and a distinct tendency of more masochistic sexual interests. CONCLUSION.: Even if the exploratory design of the present investigation allows no causal conclusions between GA and sexual homicide offenses, the result provided support for the relevance of early childhood sexual diseases in the assessment (and treatment) of offenders who have committed severe sexual violence.

Who feels affected by "out of control" sexual behavior? Prevalence and correlates of indicators for ICD-11 Compulsive Sexual Behavior Disorder in the German Health and Sexuality Survey (GeSiD).

Background and aims: The purpose of this study was to examine the prevalence and correlates of indicators consistent with Compulsive Sexual Behavior Disorder (CSBD)-defined and operationalized according to the ICD-11 guidelines-in a large (n = 4,633; 50.5% male; 49,5% female) probability-based German national sample. Methods: Participants were asked if they had ever experienced "intense and recurring sexual impulses or sexual urges that I had difficulty controlling and resulted in sexual behavior" over a period of several months. Those who reported this experience were queried about the associated distress. Results: Overall, 4.9% of men [95% CI = 3.9-6.1] and 3.0% of women [95% CI = 2.3-3.9] reported experiences consistent with ICD-11 diagnostic requirements for lifetime diagnosis. In the 12 months preceding the study, 3.2% of men [95% CI = 2.4-4.2] and 1.8% of women [95% CI = 1.2-2.5] reported experiences consistent with CSBD requirements. Compared to controls and participants who reported elements of compulsive sexuality but without accompanying distress, strict religious upbringing was most prevalent in the CSBD group. The CSBD group was more likely to view sexual practices like men having sex with men as unacceptable and to report the belief that pornography has negative impacts on their sex life and life in general. Compared to the other two groups, the CSBD group was significantly more likely to have received psychiatric treatment for depression or another mental health problem during the past 12 months. Discussion and conclusions: The current study provides novel and important insights into the prevalence and characteristics of CSBD in the general population.

Factors associated with non-use of condoms among heterosexually-active single people in Germany: Results from the first representative, population-based German health and sexuality survey (GeSiD).

Background: Against the backdrop of rising STI incidence among the heterosexual population, sexually active single people are at particularly high STI transmission risk. Gaining insight into circumstances related to condoms non-use in this population is therefore important for developing effective health interventions. Methods: The nationally-representative survey, GeSiD (German Health and Sexuality Survey) undertaken 2018-2019, interviewed 4,955 people aged 18-75 years. A total of 343 heterosexually-active single participants answered a question about condom use at last sex. Data on sociodemographic characteristics, sexual behaviours and circumstances of last sex were analysed to identify independently associated factors. Results: Condom non-use at last sex was reported more commonly by participants aged >35 years than by younger participants (48.5 vs 33.7%, respectively) and more likely among longer relationships (adjusted odds ratio [AOR]: 2.43) or early loving relationships (AOR: 3.59) than in one-night-stands. It was also associated with not discussing using condoms before sex (AOR: 6.50) and with reporting non-use of condoms at sexual debut (AOR: 4.75). Conclusions: Non-use of condoms is a common STI risk behaviour among heterosexually-active single people in Germany and so needs promoting from sexual debut throughout the life course, regardless of relationship type and age, but particularly among middle-aged and older people.

Interdisciplinary, internet-based trans health care (i²TransHealth): study protocol for a randomised controlled trial.

INTRODUCTION: Living in an area with no or deficient structures for trans health care is disadvantageous for trans people. By providing an internet-based health care programme, i²TransHealth aims at reducing structural disadvantages for trans people living in areas lacking specialised care. The e-health intervention consists of video consultations and a 1:1 chat with a study therapist. Additionally, the i²TransHealth network cooperates with physicians, who especially offer crisis intervention close to the participants' place of residence. The aim of this study is to evaluate the (cost-)effectiveness of the internet-based health care programme for trans people compared with a control (waiting) group. The following research questions will be examined with a sample of 163 trans people: Does a 4-month treatment with the i²TransHealth internet-based health care programme improve patient-reported health-outcomes? Is i²TransHealth cost-effective compared with standard care from a societal or health care payers' perspective? Does the participation in and support by i²TransHealth lead to an increase of trans-related expertise in the physician network? METHODS AND ANALYSIS: In a randomised controlled trial, the outcomes of an internet-based health care programme for trans people will be investigated. In the intervention group, participants are invited to use i²TransHealth for 4 months. Participants allocated to the control group will be able to start with their transition-related care after 4 months of study participation. The primary outcome measure is defined as the reduction of psychosomatic symptoms, as assessed by the Brief Symptom Inventory-18, 4 months after using the i²TransHealth programme. Participants in both groups will undergo an assessment at baseline and 4 months after using i²TransHealth. ETHICS AND DISSEMINATION: Positive ethical approval was obtained from the Hamburg Medical Association (PV7131). The results will be disseminated to service users and their families via media, to health care professionals via professional training and meetings and to researchers via conferences and publications. TRIAL REGISTRATION NUMBER: NCT04290286. PROTOCOL VERSION: 22 December 2021 (V.1.0).