Sexual Difficulties, Problems, and Help-Seeking in a National Representative Sample: The Second Australian Study of Health and Relationships.

The Australian Study of Health and Relationships is a large national population-representative survey of sexual behavior and attitudes conducted every decade. We describe experiences of sexual difficulties lasting at least a month among Australians surveyed in 2012-2013 and identify changes since the previous survey in 2001-2002. Computer-assisted telephone interviews were completed by 20,091 people aged 16-69 years (participation rate 66%) of whom 16,897 people had had sex with a partner in the previous year. We asked how long each difficulty lasted, whether it was a problem, and whether they sought treatment. Half (48%) the men and 68% of women reported at least one difficulty. Lack of interest in having sex was common (28% men, 52% women); 21% of men reported coming to orgasm "too quickly" and women reported inability to reach orgasm (25%) and trouble with vaginal dryness (22%). Women were more likely than men not to find sex pleasurable and to have physical pain during intercourse. Some differences by age group were also apparent. Many difficulties were not seen as problems, especially lacking interest and reaching orgasm too quickly. People with erection/dryness problems, or with pain in intercourse, were more likely to seek treatment, as were people with multiple difficulties. Between 2001-2002 and 2012-2013, there was little change for men, but among women rates of all sexual difficulties fell by 4-10 percentage points. This change accompanied a drop in frequency of sex among people in ongoing relationships and an increase in masturbation and use of pornography. One explanation might be that, over time, fewer women were agreeing to "service sex" when they were not in the mood. Overall, the drop in prevalence of women's sexual difficulties since a decade earlier suggests a change towards more egalitarian sexual relations.

Identifying gaps in dual protection from sexually transmissible infections and unintended pregnancies among Australian women: an observational study.

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

Disclosing sexuality: Gay and bisexual men's experiences of coming out, forced out, going back in and staying out of the 'closet' in prison.

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

Enhancing use of emergency contraceptive pills: A systematic review of women's attitudes, beliefs, knowledge, and experiences in Australia.

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

Meeting Sexual Partners Through Internet Sites and Smartphone Apps in Australia: National Representative Study.

BACKGROUND: Studies have reported on the proportion of the population looking for potential sexual partners using internet sites and smartphone apps, but few have investigated those who have sex with these partners, arguably a more important target group for health promotion. OBJECTIVE: This study aimed to determine the proportion of people who have had sex with someone they met on an internet site or a smartphone app in the previous year. METHODS: We analyzed data from the 2012-2013 Second Australian Study of Health and Relationships, a nationally representative telephone survey of Australian residents aged 16-69 years (N=20,091). The participation rate for the telephone survey was 66.22%. The prevalence of looking for a potential partner, physically meeting, and having sex with someone first met through an internet site or a smartphone app was estimated. Multivariate logistic regression was used for men and women separately to determine demographic and behavioral factors associated with having had sex with someone met on an internet site or a smartphone app in the last year. RESULTS: Overall, 12.09% of respondents had looked for potential partners using these technologies and 5.40% had done so in the last year. In the last year, 2.98% had met someone in person and 1.95% reported having had sex with someone first met on an internet site or a smartphone app. The prevalence of all behaviors was greater in men than in women and in younger respondents than in older respondents. Among sexually active men, factors associated with having had sex with someone met using internet sites or smartphone apps included identifying as gay or bisexual (adjusted odds ratio, AOR: 15.37, 95% CI 8.34-28.35), having either 2-3 or >3 sexual partners in the last year (AOR: 9.20, 95% CI 9.20-34.68 and AOR: 35.77, 95% CI 18.04-70.94, respectively), having had a sexually transmissible infection (STI) test in the past year (AOR: 2.02, 95% CI 1.21-3.38), or an STI in the last year (AOR: 3.15, 95% CI 1.25-7.97). Among sexually active women, factors associated with having had sex with someone met on an internet site or a smartphone app were as follows: having either 2-3 or >3 sexual partners in the last year (AOR: 32.01, 95% CI 13.17-77.78 and AOR: 71:03, 95 % CI 27.48-183.57, respectively), very low and low income (vs very high AOR: 3.40, 95% CI 1.12-10.35), and identifying as lesbian or bisexual (AOR: 2.27, 95% CI 1.04-4.49). CONCLUSIONS: More than a third of adults who had looked for potential partners using websites and apps each year had sex with such partners, and those who had done so were more sexually active, suggesting that dating and hookup websites and applications are suitable settings for targeted sexual health interventions.

Differences Between Landline and Mobile Phone Users in Sexual Behavior Research.

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

Performing (heterosexual) femininity: female agency and role in sexual life and contraceptive use - a qualitative study in Australia.

Women's liberation and the sexual revolution have changed the social landscape for heterosexual women in the West over the past 50 years, but exploration of women's lived experiences of contraceptive use in the context of their sexual lives is comparatively recent. We conducted 94 in-depth open-ended interviews with women of reproductive age (16-49 years) living in New South Wales, Australia. Interviews were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach. Four major themes are explored here: (1) what women do and do not do: unspoken gendered assumptions; (2) focus on partner's pleasure; (3) juggling responsibilities: sex as a chore; and (4) women's sexual motivations. Findings suggest sexual double standards and gender expectations continue to pervade women's sexual and contraceptive practices. We found that women performed their femininity by focusing on enabling their male partner's pleasure, while simultaneously ignoring their own sexual desires, wishes or interests. Accompanying new-found freedoms are new-found responsibilities, as women now add managing modern contraceptives and a good sex life to their list of tasks alongside paid employment, domestic labour and childrearing. Our research findings suggest that women may derive different pleasures from sex, including what we term 'connection pleasure'.

Factors Associated With Sexual Coercion in a Representative Sample of Men in Australian Prisons.

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

Contraceptive choices and sexual health of Japanese women living in Australia: A brief report from a qualitative study.

BACKGROUND: There is a lack of research focused specifically on the contraceptive and sexual health practices of Japanese women living in Australia. OBJECTIVE: This paper reports findings from a cohort of migrant Japanese women who participated in a study of Australian women's understanding and experience of contraceptives. METHODS: In-depth, open-ended interviews were conducted between August 2012 and June 2013 in New South Wales. Audio-recorded interviews of seven Japanese women were transcribed verbatim and analysed thematically. RESULTS: The four prominent themes were the condom and withdrawal methods, varying attitudes to contraceptive practices, discussing contraception and sexual issues with general practitioners (GPs), and the unspoken topic of sexually transmissible infections (STIs). DISCUSSION: Japanese migrants tend to choose the condom and withdrawal methods, which they perceive to be 'standard practice' in Japan. A greater understanding by Australian GPs of Japanese women's attitudes to contraception and sexual health issues could enhance the sexual health of Japanese women.

Australian women's experiences of the subdermal contraceptive implant: A qualitative perspective.

BACKGROUND: The number of prescriptions for contraceptive implants has steadily increased in Australia, but implant use is still low. OBJECTIVE: The objectives of the study were to describe women's nuanced responses, and characterise their multidimensional and complex reasons for (dis)continuing use of the contraceptive implant. METHODS: A descriptive qualitative approach was used for this study. A larger qualitative study using in-depth, open-ended interviews, conducted in New South Wales between 2012 and 2013 with 94 women aged 16-49 years who had used contraception, included 10 interviews containing accounts of implant use. The 10 interviews were analysed thematically in the present study. RESULTS: The three main themes analysed from the 10 interviews were perceived benefits, undesirable experiences and perseverance. DISCUSSION: The participants were well informed about the benefits of the implant. Many persevered with it for a significant period of time before discontinuing it, despite experiencing side effects such as bleeding or mood changes. A decision to discontinue was often only made after an accumulation of multiple side effects.

Condoms for prisoners: no evidence that they increase sex in prison, but they increase safe sex.

OBJECTIVES: To determine if the provision of condoms to prisoners in two Australian state prison systems with different policies affects sexual behaviour. In New South Wales' (NSW) prisons, condoms are freely distributed, while in Queensland prisons none are distributed. METHODS: We used a computer-assisted telephone interview to survey randomly selected prisoners in both states about their sexual behaviour in prison. RESULTS: Two thousand and eighteen male prisoners participated. The proportion of prisoners reporting anal sex in prison was equally low in NSW (3.3%) and Queensland (3.6%; p=0.8). A much higher proportion of prisoners who engaged in anal sex in NSW (56.8%) than Queensland (3.1%; p<0.0001) reported they had used a condom if they had had anal sex in prison. Sexual coercion was equally rare in both prison systems. CONCLUSIONS: We found no evidence that condom provision to prisoners increased consensual or non-consensual sexual activity in prison. If available, condoms were much more likely to be used during anal sex. Condoms should be made available to prisoners as a basic human right.

Incidence and persistence/recurrence of men's sexual difficulties: findings from the Australian Longitudinal Study of Health and Relationships.

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

A population-based study investigating the association between sexual and relationship satisfaction and psychological distress among heterosexuals.

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

Incidence and persistence/recurrence of women's sexual difficulties: findings from the Australian Longitudinal Study of Health and Relationships.

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

Consensual sex between men and sexual violence in Australian prisons.

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

Organised abuse: a neglected category of sexual abuse with significant lifetime mental healthcare sequelae.

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

Reproductive experiences and outcomes among a representative sample of women: the Second Australian Study of Health and Relationships.

OBJECTIVE: To enumerate pregnancy outcomes for a representative sample of women in Australia surveyed in 2012-2013 (primary aim) and compare these with women surveyed in 2001-2002 (secondary aim). METHODS: Computer-assisted telephone interviews with over 10,000 women aged 16-69 years (participation rate 68.4%). Results are weighted for chance of selection and to reflect the population as a whole. RESULTS: Of women with experience of vaginal intercourse, 75.1% had ever been pregnant, 18.4% reported difficulties getting pregnant and 10.0% had had fertility treatment. Of those who had been pregnant, 91.3% had ever had a live birth, 34.3% a miscarriage, 22.8% an abortion and 2.3% a stillbirth; 0.9% had relinquished a child for adoption. The proportion first pregnant in their 30s was 11% among women aged 60-69 and 26% among those aged 40-49. Fewer older women reported difficulties getting pregnant. Of the 21,882 pregnancies reported, 70% led to live births and 10% were terminated. Compared with our 2001-2002 survey, fewer women reported ever having been pregnant. Giving up newborns for adoption has become very rare. CONCLUSIONS: Falling fertility since the 1960s reflects greater access to contraception and abortion and higher opportunity costs of childbearing. Implications for public health: These findings on women's lifetime reproductive experiences complement routine annual data collections.

Sexual and relationship satisfaction among heterosexual men and women: the importance of desired frequency of sex.

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

High prevalence of symptoms associated with ovarian cancer among Australian women.

BACKGROUND: Symptoms associated with ovarian cancer are often vague and non-specific, such as abdominal bloating and pain. Presently, nothing is known about the prevalence of these symptoms among women in the community. AIMS: To identify the prevalence and correlates of symptoms associated with ovarian cancer in a nationally representative sample of Australian women. METHODS: Women answered questions about symptoms associated with ovarian cancer via computer-assisted telephone interviews. Binomial regression was used to assess the association between reporting symptoms, demographic characteristics and sexual problems. RESULTS: Data on 2235 women aged 18-70 who had not had an oophorectomy or hysterectomy were analysed. Prevalences of symptoms were abdominal bloating 52%, abdominal pain 37%, increased abdominal size 30%, pelvic pain 29%, feeling full quickly 18% and unable to eat normally 15%. One-third of women (32%) reported three or more symptoms, 2% reported all six and 32% of women reported none. Severe symptoms were generally reported by <10% of women reporting symptoms, and symptoms usually persisted for 5 days or less a month. Older women were less likely to report symptoms, as were women who had been pregnant. There was an association between symptoms and sexual difficulties whereby women who reported multiple ovarian cancer symptoms were more likely to report sexual problems. CONCLUSIONS: There is a high prevalence of ovarian cancer symptoms in the Australian community. Because of this, awareness campaigns will likely impact a large number of women who do not have ovarian cancer.

Psychological distress and experience of sexual and physical assault among Australian prisoners.

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