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.

Men Who Pay For Sex: Prevalence and Sexual Health.

BACKGROUND: Men who pay for sex (MPS) are a vulnerable bridging population for spreading sexually transmitted infections (STI). However, their prevalence and sexual health are unknown in Germany. METHODS: We analyzed data from 2336 men aged 18-75 years resident in Germany who completed the German Health and Sexuality Survey (GeSiD), a populationbased probability sample survey undertaken 2018-2019, using face-to-face interviews (participation rate: 30.2%). RESULTS: 26.9% (95% confidence interval [24.7; 29.2]) of all men reported ever paying for sex. On average, MPS had M = 19.9 [16.8; 22.9] lifetime sexual partners, among them M = 7.3 [5.3; 9.4] paid partners. MPS described their paid sex predominantly as vaginal intercourse in domestic brothels. Regarding socio - demographic characteristics, MPS differed from men not paying for sex (MNPS) in terms of age, immigration status, and sex education. Compared to MNPS, MPS reported significantly more HIV/STI risk-taking, including multiple sex partners in the past year (OR adjusted for age, immigration status, sex education; AOR 3.55) and STI diagnosis in the past 5 years (AOR 1.96) as well as more prevention behaviors (e.g., condom use in the past year: AOR 3.13). CONCLUSION: The prevalence of MPS suggests physicians should address the topic with their patients to protect and improve the sexual health of MPS and their paid and unpaid partners.

[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.

Methodology of the German National Sex Survey - GeSiD (German Health and Sexuality Survey).

The German Health and Sexuality Survey (GeSiD) was carried out in 2018/2019 to provide up-to-date measures of sexual behavior, sexual attitudes and sexual lifestyles of the adult population. We describe the methods used in GeSiD which surveyed the general population in Germany aged 18-75 years (with oversampling of younger adults aged 18-35 years). This article focuses on study design, recruitment, and response rate and discusses the strategies implemented to enhance the response rate compared to the pilot study. Overall, 4.955 interviews were completed with a response rate of 30.2%. The data were weighted by age, gender, education, nationality, and region to reduce possible bias. Compared to the German 2018 census, the weighted sample provides good representativeness for selected respondent characteristics. The computer-assisted interviews consisted of a combination of face-to-face and self-completion components. They covered a broad perspective on sexual health, which included topics such as online sexual activities, pleasure, sexual dysfunction, and sexual violence. Reliable data on sexual and reproductive health in Germany are urgently needed for evidence-based prevention and health promotion work, to inform sexual health policy and for cross-national comparisons of the development of sexual behavior in Europe.

Health, Sexual Activity, and Sexual Satisfaction.

BACKGROUND: Physical and mental health disorders can markedly affect sexual activity and sexual satisfaction. Until now, there has been a lack of representative data from the German population that could serve as a basis for demonstrating specific links between sexuality and health. METHODS: In the German Health and Sexuality Survey (GeSiD), 4955 men and women in a two-step stratified random sample drawn from local resident registration offices across Germany were surveyed by questionnaire. The response rate was 30.2%. The questions involved, among other things, the respondents' selfassessment of sexual activity and sexual satisfaction, general health status, and any chronic illnesses or disabilities. RESULTS: The percentage of respondents who reported having been sexually active with one partner in the past four weeks was highest among men aged 36 to 45 and women aged 26 to 35. In male respondents, the likelyhood of having been sexually active in the past four weeks decreased from 79.1% to 59.0% and 30.1%, respec - tively, if they described their own health status as fair or bad compared with those in very good health. In female respondents the decrease was from 72.5 % to 48.0 % and 32.4%, respectively. A comparable association was found with self-reported chronic illnesses and disabilities that were perceived as impairing sexuality. Sexual satisfaction was present to a similar extent in all age groups. CONCLUSION: Self-reported physical and mental illnesses are often associated with marked impairment of sexuality. Even illnesses without any immediately evident relation to sexuality often affect aspects of sexual health. It is, therefore, advisable for physicians to address their patients' sexuality routinely in everyday clinical practice.

Estimating the Prevalence of Sexual Dysfunction Using the New ICD-11 Guidelines.

BACKGROUND: The 11th edition of the International Statistical Classification of Diseases (ICD-11) is due to come into force in 2022. The goal of the present partial evaluation of the GeSiD study findings is to provide the first ever estimate of the prevalence of different types of sexual dysfunction in Germany as defined by the diagnostic guidelines that are soon to take effect. METHODS: The representative GeSiD study was carried out in 4955 men and women who belonged to a doubly stratified random sample of data from residence registration offices across Germany. The participation rate was 30.2%. Various types of sexual dysfunction were ascertained for the first time by means of a screening instrument based on the new ICD-11 guidelines. RESULTS: The reported prevalence of one or more sexual problems, including mild distress, in the previous 12 months was 33.4% in men (95% confidence interval [31.0; 35.9]) and 45.7% in women [43.0; 48.4]. Some 80.4% of men and 72.1% of women stated that they had had at least one sexual contact in the past year. Sexual dysfunction causing marked distress, as per the ICD-11 guidelines, was reported by 13.3% [11.6; 15.1] of the sexually active men (most commonly, erectile dysfunction in 6.6% and early ejaculation in 4.5%), and by 17.5% [15.6; 19.6] of the sexually active women (most commonly, hypoactive sexual desire in 6.9% and orgasmic dysfunction in 5.8%). Orgasmic dysfunction was approximately twice as common in women as delayed ejaculation was in men. The prevalence of erectile dysfunction increased with age, while that of early ejaculation decreased. Women felt particularly impaired by pain associated with sexual activity. CONCLUSION: The findings of this study indicate the importance of sexual dysfunction as an obstacle to sexual health. The study provides the first prevalence estimates for the new ICD-11 guidelines and simultaneously offers a screening instrument for sexual dysfunction that can be used economically in routine practice.

[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.

[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.