Sexual wellbeing

Introduction

Preventing STIs and unwanted pregnancies are important aspects of the strategies currently being pursued to improve sexual health outcomes in Scotland. However, it is increasingly recognised that positive sexual health and wellbeing outcomes span a broader range of areas beyond disease prevention and contraception. For example, the Sexual Health and Blood Borne Viruses Framework 2015-2020 highlights the importance of relationships free from coercion or harm, the impact of sexual dysfunction on wellbeing, and the harmful role wider social stigma and homophobia can play in preventing people from accessing sexual health services. 

Data sources

Data on these kinds of wider sexual health and wellbeing issues are not available from the routine administrative sources that provide data on outcomes such as STIs and pregnancies. However, population surveys such as the National Surveys of Sexual Attitudes and Lifestyles (NATSAL) series (conduced in 1990, 2000 and 2010-12), the Scottish Government’s Sexual Health and Wellbeing Survey, and the Scottish Social Attitudes (SSA) survey provide such data. This page is presenting the latest available data.

The information reported here comes from the following sources:

• The NATSAL-3 Scottish report, published in March 2015 (behavioural indicators, sexual function, coercion and harm).
• The 2015 Scottish Social Attitudes (SSA) survey discrimination report  published in 2016 (which reports on trends in attitudes to same-sex relationships since 2000)
• The 2019 Scottish Social Attitudes (SSA) survey of violence against women.
• The NATSAL-COVID report, published in January 2022, which looked at Scotland-specific data on sexual behaviour, and sexual and reproductive health during the first year of the Covid-19 pandemic

Contextual information on risk behaviours

The table below presents data for a small selection of indicators of risky sexual behaviour of potential interest to sexual health service planners and policy makers. A wider range of information is available in the NATSAL-3 Scottish report and in the main UK-wide reports.

NATSAL-3 Scottish report suggests evident generational differences in the age at which people had their first heterosexual intercourse (people aged 16-45 years are more likely to report having had intercourse before the age of 16 years than those aged 45-74 years). Furthermore, recent sexual behaviour also shows generational differences: people aged 16-29 years are the most likely to have had multiple sexual partners in the past year, and to have had intercourse with two or more partners without a condom in the past year. Note that the sample size in Scotland is too small to be able to present equivalent figures for same-sex experiences.

The key indicator for unsafe sex as defined by NATSAL-3 is having sex with two or more partners in the past year without using a condom. Two other risk behaviours reported here are having sex with a new partner from outside the UK and paying for sex.

Sexual function

Sexual function can be defined as “the extent to which an individual is able to participate in and enjoy a sexual relationship” (Mitchell et al 2013).

NATSAL-3 measured sexual function using a 17-item scale that asked people to assess three components of their sexual lives: their own sexual difficulties (physiological or psychological), sexual difficulties within relationships, and a broader appraisal of satisfaction and difficulties in their sex life (full details available here). Total scores were used to identify people with scores in the lowest fifth of the overall distribution. In Scotland, 18% of men and 21% of women had low sexual function. Low sexual function did not vary by age among men, but it doubled from 16% in women aged 16-29 years to 29% for women aged 45-74 years. One item within the sexual function scale asked people to rate their overall satisfaction with their sex life. Among those with at least one sexual partner in the previous year, 17% of men and 12% of women reported dissatisfaction with their sex life. Levels of dissatisfaction did not vary by age.

Analysis of the GB-wide data showed that 39% of people with bad or very bad self-assessed health had low sexual function compared with 18% of those with very good or good health. Around one in six adults in Scotland reported a health problem or disability that affected their sex life (14% of men, 15% of women) (Natsal 3: Key Findings from Scotland, 2015) (available from NRS).

Coercion and harm

NATSAL can be used to identify the prevalence of adults in Scotland who have experienced someone attempting to have sex with them against their will since the age of 13 years (attempted non-volitional sex), and those who have experienced someone having sex with them against their will (completed non-volitional sex). Women were five times as likely as men to have experienced attempted non-volitional sex (19% versus 4%) and completed non-volitional sex (10% versus 2%). More detailed analysis of the GB-wide data showed that the groups most at risk of these experiences included younger people and men who have sex with men.

Experiencing attempted and completed non-volitional sex was associated with a range of other adverse outcomes, such as poor mental health, substance misuse, early pregnancy or terminations (in women), multiple sexual partners, STI diagnoses and low sexual function. These associations were not necessarily causal, but they do highlight the extent that these adverse outcomes cluster.

Attitudes to sexual violence and sexual harassment

The SSA 2019 survey reports that the majority of people thought the behaviour of a man raping a stranger (91%) was 'very seriously wrong' compared with a man raping his wife (84%). There was a 10-percentage-point increase from 2014 to 2019 in the proportion of people who thought that rape within a marriage was 'very seriously wrong', but no equivalent increase was seen in views on a man raping a stranger.  Those presented with the scenario of rape by a stranger were more likely than those presented with the scenario of rape within marriage to think the man's actions caused the woman 'a great deal' of harm - 89% and 80% respectively The proportion believing this about rape within a marriage increasing from 67% in 2014 to 80% in 2019. The figure for the rape of a stranger increased by 4 percentage points from 85% to 89% between 2014 and 2019. More information can be found in SSA 2019 report (640KB).

People were also asked how wrong they considered three forms of sexual harassment to be. Sexual harassment in the workplace was the most likely to be considered 'very seriously wrong' (45%), while the equivalent figures for a group of men wolf-whistling and a man sending unwanted gifts to his ex-girlfriend were 39% and 30% respectively. More information can be found in SSA 2019 report (640KB).

Attitudes to same-sex relationships

The Scottish Social Attitudes 2015 survey reports that the proportion of adults aged 18 years and over in Scotland who say that sexual relationships between people of the same sex are always or mostly wrong declined from 48% in 2000, to 18% in 2015. At the same time, the proportion saying such relationships are rarely wrong or not wrong at all increased from 37% in 2005 to 69% in 2015. Other measures of attitudes towards same-sex relationships have seen similar changes. Between 2006 and 2015, the proportion of adults in Scotland saying they would be unhappy if a close relative married or formed a long-term relationship with someone of the same sex halved from 33% to 16%.

Sexual health and wellbeing during Covid-19

Data come from survey wave 2 of the Natsal-COVID study, an online web-panel survey of 6,658 participants across Britain, out of which 573 were Scottish.  66% of men and 73% of women in Scotland reported at least one sexual partner during the year from the first lockdown in March 2020. Among sexually experienced Scottish participants who reported having at least one partner in 2020 (n=347), 20% had at least one new partner.  Overall, 65.5% of participants with at least one new partner in 2020 reported a new condomless partner (67% in men and 62% in women).

Sexual health was reported as important by 54% of participants living in Scotland over the first year of the pandemic. Overall, reporting sexual health as being very important or somewhat important was similar between men and women. Those in steady relationships were more likely to report their sexual health as being very or somewhat important than those not in steady relationships (61% steady relationships; 42% not in a steady relationship), regardless of gender. Overall, 27% of men and 17% of women living in Scotland reported that they were feeling distressed or worried about their sex lives. This was higher in men (23%) than women (15%) among those sexually active, and men (36%) and women (19%) among sexually inactive participants.

Overall, 28% of sexually experienced respondents aged 18-44 living in Scotland reported accessing at least one sexual and reproductive health (SRH) service during the year following the first lockdown, with women (40%) more likely to report this than men (15%). By individual service, 14% reported using contraception services or advice (24% women; 4% men) and 6% reported using an STI service (no differences between women and men).