Elsevier

Annals of Epidemiology

Volume 23, Issue 10, October 2013, Pages 620-628
Annals of Epidemiology

Original article
Sexual health and socioeconomic-related factors in Spain

https://doi.org/10.1016/j.annepidem.2013.07.005Get rights and content

Abstract

Purpose

The aim of the present study was to describe sexual health in Spain according to three important indicators of the World Health Organization definition and explore the influence of socioeconomic factors.

Methods

We performed a population-based cross-sectional study of sexually active people aged 16-44 years residing in Spain in 2009 (2365 women and 2532 men). Three main aspects of sexual health were explored: sexual satisfaction, safe sex, and sexual abuse. The independent variables explored were age, age at first intercourse, reason for first intercourse, type of partner, level of education, country of origin, religiousness, parity, and social class. Bivariate and multivariate logistic regression models were fitted.

Results

Both men and women were quite satisfied with their sexual life, their first sexual intercourse, and their sexual relationships during the previous year. Most participants had practiced safe sex both at first intercourse and during the previous year. Levels of sexual abuse were similar to those in other developed countries. People of disadvantaged socioeconomic position have less satisfying, more unsafe, and more abusive sexual relationships. Women experienced more sexual abuse and had less satisfaction at their first intercourse.

Conclusions

The state of sexual health in Spain is relatively good. However, we observed inequalities according to gender and socioeconomic position.

Introduction

The term sexual health is increasingly used by researchers as the context of empirical studies, although there is little agreement in its definition. The World Health Organization (WHO) endorses a broad definition: "Sexual health is a state of physical, emotional, mental, and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction, or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled" [1].

The WHO definition has merit in underlining the importance not only of preventing adverse sexual health outcomes but also of maintaining those that are beneficial, including satisfaction and sexual function. Satisfying sexual experience within a relationship has been shown to contribute markedly to overall relationship satisfaction, and this sense of well-being contributes to better health [2]. These associations are seen in both men and women, although the link between sexual satisfaction and relationship quality appears to be stronger among men [3].

Sexual satisfaction is also related to the practice of safe sex. The use of contraceptive methods is the most effective means of preventing unintended pregnancy and/or sexually transmitted infections (STIs), and the initial and continued use of contraceptive methods are influenced by their impact on sexual pleasure and satisfaction [4], [5].

Similarly, sexual violence against women, which is recognized as a global public health and human rights problem in need of urgent attention, has been shown to directly increase the risk of STIs and unwanted or mistimed pregnancies, and the physical and mental effects may last long after the violence has ended [6], [7], [8]. Furthermore, this abuse may be a marker of more general malaise: evidence suggests that most women who report having suffered violence at the hands of their partners had experienced either a combination of physical and sexual violence or physical violence alone rather than only sexual violence [9]. This problem is not insignificant; according to one study that analyzed different cities around the world, 35%-76% of women had experienced physical or sexual assault after the age of 15 years, mainly by a current or previous partner [6], [9].

The aim of the present study was to describe sexual health in Spain according to three important indicators of the WHO definition of sexual health, sexual satisfaction, safe sex, and experience of sexual abuse, and explore the influence of socioeconomic factors. Where the data allow, these were explored at different points in the life span of the individual using response options related to their first experience of sexual intercourse, experiences during the previous year and sexual life in general. As far as we are aware, there have been no attempts to describe sexual health status in this more broad way, and there has been virtually no population-based research on sexuality issues in Spain. The implementation of a new National Strategy for Sexual and Reproductive Health [10], whose aim was to improve the sexual health status of the general population, has created an urgent need for more data on this issue.

Section snippets

Design, setting, and patients

In this article, we present data from a population-based cross-sectional study of noninstitutionalized sexually active people aged 16-44 years residing in Spain in 2009.

The information source for this study was the first Spanish National Sexual Health Survey (SNSHS), supported by the Women's Health Observatory of the Spanish Ministry of Health, Social Policy and Equality and carried out in 2009 by the Centre for Sociological Research [11]. The survey consisted of a face-to-face interview

Results

Due to variation in the sample size for each dependent variable, we have included the results of a descriptive analysis in the first three columns of each table (Table 1, Table 2, Table 3, Table 4, Table 5, Table 6, Table 7).

Discussion

In this study, we observed that men and women were reasonably equally satisfied with their sexual life and with the sexual intercourse they had had with a regular partner the previous year. Fewer women than men had had sexual intercourse with a casual partner during the previous year and those who had reported generally less satisfying experiences. The greatest gender differences were apparent in satisfaction after first intercourse, with which 86% of men, but only 61% of women, declared that

Acknowledgments

We would like to dedicate this article to the memory of Concha Colomer Revuelta (1954-2011), Subdirector General of the Health Planning Office and Director of the Women's Health Observatory of the Spanish Ministry of Health, Social Policy and Equality, who promoted and supported the first Spanish National Sexual Health Survey in 2009, the source of the data analyzed in the present study.

This article forms part of the doctoral dissertation of Dolores Ruiz Muñoz at the Pompeu Fabra University

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