Sexual health indicators for the United States: Measuring progress and documenting public health needs.

Introduction: Today, we are facing increased and continued adverse sexual health outcomes in the United States, including high post-COVID-19 pandemic rates of sexually transmitted infections (STIs). For the past 20 years, there have been calls for a national health strategy and a more comprehensive sexual health approach to address the myriad of persistent sexual health problems in this country. Employing a sexual health approach requires shifting from a longstanding, stigmatizing focus on morbidity toward a holistic and integrated focus on health rather than disease. While strategies are being implemented by multisectoral stakeholders, it is also important to establish a core set of indicators that broadly describe the state of sexual health in the U.S. and allow for measurement across time. The development of a comprehensive scorecard with key sexual health indicators has been proposed by other entities (e.g., Public Health England, World Health Organization), but such an attempt has not been made in the U.S. Methods: A review of national U.S. surveys and surveillance systems with items related to sexual health was conducted for years 2010-2022 to develop an inventory of existing data that yield national estimates for potential indicators of sexual health. Results: We selected 23 sexual health indicators in four broad domains including: (1) knowledge; communication and attitudes (five indicators); (2) behaviors and relationships (four indicators); (3) service access and utilization (seven indicators); and (4) adverse health outcomes (seven indicators). Recent data for each indicator are provided. Discussion: A growing body of evidence shows the positive effects of moving away from a morbidity focus toward an integrated, health-promoting approach to sexual health. Yet, not much has been done in terms of how we implement this national shift. We argue that measurement and monitoring are key to future change. We envision these core sexual health indicators would be published in the form of an index that is publicly available and updated frequently. These sexual health indicators could be used for ongoing monitoring, and to guide related research, programming, and policy development to help promote sexual health in coming years.

Masturbation Prevalence, Frequency, Reasons, and Associations with Partnered Sex in the Midst of the COVID-19 Pandemic: Findings from a U.S. Nationally Representative Survey.

Despite well-documented individual, relational, and health benefits, masturbation has been stigmatized and is understudied compared to partnered sex. In a US nationally representative survey of adults, we aimed to: (1) assess the prevalence and frequency of participants' prior-year masturbation, (2) describe reasons people give for not masturbating, (3) describe reasons people give for masturbating, and (4) examine the association between masturbation frequency and actual/desired partnered sex frequency in the prior year. Significantly more men than women reported lifetime masturbation, past month masturbation, and greater masturbation frequency. The most frequently endorsed reasons for masturbating related to pleasure, feeling "horny," stress relief, and relaxation. The most frequently endorsed reasons for not masturbating were lack of interest, being in a committed relationship, conflict with morals or values, or being against one's religion. Among women, those who desired partnered sex much more often and a little more often were 3.89 times (95% CI: 2.98, 5.08) and 2.07 times (95% CI: 1.63, 2.62), respectively, more likely to report higher frequencies of past-year masturbation than those who desired no change in their partnered sex frequency. Among men, those who desired partnered sex much more often and a little more often were 4.40 times (95% CI: 3.41, 5.68) and 2.37 times (95% CI: 1.84, 3.06), respectively, more likely to report higher frequencies of past-year masturbation activity than those who reported that they desired no change in their current partnered sex frequency. Findings provide contemporary U.S. population-level data on patterns of adult masturbation.

Compulsive Sexual Behavior and Changes in Solitary Sexual Behaviors During the COVID-19 Pandemic.

The aim of with this brief report is to examine how the COVID-19 pandemic differentially impacted solitary sexual behaviors in those with and without clinically significant compulsive sexual behavior (CSB). A total of 944 individuals in the United States completed an online cross-sectional survey in October 2020. Participants were asked to retrospectively report their frequency of masturbation and pornography use during the pandemic and prior to the pandemic. Participants also completed assessments of CSB, depression symptoms, and experiences of financial stress caused by the pandemic. Individuals who screened positive for clinically significant CSB reported statistically significant increases in masturbation and pornography use during the pandemic. Those who screened negative for CSB reported no significant increase in masturbation and a very small, statistically significant increase in pornography use. Those screening positive for CSB also reported significantly higher levels of depression symptoms but did not report increased likelihood of experiencing financial distress due to the pandemic. This suggests that increases in masturbation and pornography use reported by some, but not all, recent studies on sexual behaviors during the COVID-19 pandemic may be driven by individuals with CSB. Future research on sexual behaviors during the pandemic should assess CSB to further clarify its relationship with sexual behavior changes.

"Sex Seems Less Important When You Are Worried About a Deadly Virus." A Content Analysis of Reported Reasons for Changes in Sexual Behavior and Satisfaction During the COVID-19 Pandemic.

The purpose of this study is to assess how the COVID-19 pandemic impacted various sexual behaviors and levels of sexual and relationship satisfaction by performing a content analysis of participants' (N = 1051 American adults) responses to open-ended survey questions. Results revealed a variety of impacts that increased, decreased, or otherwise qualitatively changed sexual behavior and satisfaction. Major themes included emotions and mental health, changes in routines, social distancing and fears related to COVID-19, and changes in romantic relationships. These findings are contextualized within the emerging quantitative research on COVID-19 and sexuality, and areas for future research based on these findings are discussed.

The Impact of the COVID-19 Pandemic on Sexual Behaviors: Findings From a National Survey in the United States.

BACKGROUND: Studies from the first months of the coronavirus disease 2019 (COVID-19) pandemic and the resulting lockdown and social distancing measures have shown that there have been decreases in sexual frequency and relationship satisfaction. AIM: To evaluate the ongoing impact of the COVID-19 pandemic on sexual behavior, relationship satisfaction, and intimate partner violence in the United States using a large national convenience sample. METHODS: About 1,051 participants across the United States were recruited in October 2020 to complete a cross-sectional online survey. OUTCOMES: Participants were asked to retrospectively report their sexual behavior frequency, relationship satisfaction, and intimate partner violence during the pandemic and prior to the pandemic RESULTS: There was a small but significant decrease in some retrospectively-reported partnered sexual activities, and men reported a small increase in masturbation and pornography use. There was no evidence for a change in relationship satisfaction or intimate partner violence, but both men and women reported a small decrease in sexual pleasure, and women reported a small decrease in sexual desire. The sexual behaviors with greatest reduction were casual sex, hookups, and number of partners, and the most diminished as aspect of sexual functioning was sexual enjoyment. Depression symptoms, relationship status, and perceived importance of social distancing emerged as predictors of these reductions. Less than half of individuals who engaged with casual sex partners before the start of the pandemic ceased this behavior completely after the start of the pandemic. Individuals waited on average 6-7 weeks before reengaging in casual sex. CLINICAL IMPLICATIONS: These results inform public health response to the effects of the pandemic and add to our understanding of how the pandemic has continued to impact sexual behavior. STRENGTHS AND LIMITATIONS: This is the first known study to evaluate sexual behavior several months into the COVID-19 pandemic using a large national sample. However, the results of this study are limited by its convenience sampling method and cross-sectional design. CONCLUSION: These results indicate that the changes in sexual behavior observed in the early months of the pandemic have continued, with small but significant decreases in many partnered sexual behaviors and a small increase in men's solitary sexual behaviors. Gleason N, Banik S, Braverman J, et al. The Impact of the COVID-19 Pandemic on Sexual Behaviors: Findings From a National Survey in the United States. J Sex Med 2021;18:1851-1862.

Teaching Sexual History Taking in Health Care Using Online Technology: A PLISSIT-Plus Zoom Approach During the Coronavirus Disease 2019 Shutdown.

AIM: Cancellation of university classes during the coronavirus disease 2019 pandemic challenges teaching inperson sexual history-taking skills to medical, physician assistant, and nursing students. We used commercial online electronic services for medical students to learn sexual history-taking skills. METHODS: A total of 174 medical students viewed a lecture on sexual history taking and the PLISSIT model (Permission, Limited Information, Specific Suggestion, Intensive Therapy) and were then randomized into dyads. They arranged a time to meet online on Zoom with their partner, chose a simple sexual history case-history (male or female) from a small selection, and recorded the 5- to 6-minute sexual history within a 1-week time frame. Each student played a "provider" or "patient" and then switched roles with a new case. One of the course tutors, all sexual health practitioners, downloaded 10 videos randomly assigned to them asynchronously and viewed and commented on the interaction of each "provider" along with comments on what to improve in the sexual history. 2 weeks later after the remainder of the lectures in the course, a second, more complex set of 8 cases were provided, so students could move at their comfort pace and choose 1. MAIN OUTCOME MEASURE: Students were required to make 1 online post and 1 comment on another student's post for each case, on the experience, and associated issues arising, positive or negative. All comments were downloaded and analyzed by theme. RESULTS: Major themes included developing comfort in using sexual language, using simpler sexual terms suitable for patients, feeling confidence and mastery, excitement using technology developing clinical skills, surprise watching their performances and body language, observation of how they appeared to the "patient," organizing sexual histories and incorporating PLISSIT model, ability to ask about context and relationships, and seeing the exercise as building on existing clinical skills training. Some expressed anxiety and nervousness, which by the second case had largely or completely dissipated. CONCLUSION: A readily replicable, secure, cheap cloud-based model to integrate sexual history training asynchronously was provided, with tutors' comments, and student skills development, and performance evaluated. Ross MW, Newstrom N, Coleman E. Teaching Sexual History Taking in Health Care Using Online Technology: A PLISSIT-Plus Zoom Approach During the Coronavirus Disease 2019 Shutdown. Sex Med 2021;9:100290.