As the rate of STD increases and studies in the US show a decrease in sexual activity, one might wonder how the state of sexual health could have become so terrible. Let us debunk some of these studies and see what might be hiding behind the numbers.
The Health and Behaviour in School-aged Children international report from the 2021/2022 survey, showed interesting findings. The survey focuses on sexual health and behaviours in young people in Europe, Central Asia and Canada and reveals that:
“Around a third of adolescents (30% of boys and 36% of girls) did not use a condom at last sexual intercourse and a further 9% of boys and 7% of girls did not know if they or their partner had used a condom. These rates varied widely across countries and regions.”
Recent data from the Nordic Health & Welfare Statistics, NHWS, shows that there has been a progressive increase in STD cases since 2000. It is important to note that the data is only available from 2000. The highest number of cases on a scale of 100 000 people remains Chlamydia. Other STDs, like Gonorrhoea has known a sharper increase than syphilis, however these increase can still warrant some concern regarding public health.
The use of contraception could be decreasing as well, increasing the risk of unplanned pregnancy in return. The sample used in this study wasn’t separated by countries, meaning that there are not exact numbers to know the scale of this issue in Sweden. The survey was distributed and results were collected in Sweden from January to 2022 to June 2022.
“30 percent of sexually active boys and 31 percent of sexually active girls reported using neither condom nor contraceptive pill at last sexual intercourse. This is similar to rates observed in 2018.”
In Sweden, STDs are classified as Notifiable Diseases. Each disease falls into several categories, notifiable, subject to mandatory contact tracing, and dangerous to public health and society. Chlamydia, Syphilis, Gonorrhea, and HIV/AIDS are all subject to mandatory contact tracing, notifiable, and are considered dangerous to society. This system alone could influence the increase of cases in Sweden. Even though data shows a decrease in cases of Syphilis and Gonorrhea at the beginning of the 2000s there has been a general increase in STD cases in the past 5 years which raises concern for public health.
There are several reasons as to why cases have increased this much since the 2000s. The Nordic Health & Welfare Statistics explains in an editorial:
“The registered increase in incidence of sexually transmittable diseases is partly a question of increased case detection.”
The NHWS explains that there are several reasons as to why that could be, such as people traveling further and more often. Most importantly, an increase in Gonorrhea is a public health concern as it could become resistant to treatment. A case of antimicrobial-resistant Gonorrhea was detected in England in 2016 in a heterosexual male. Since then, more cases of antimicrobial-resistant Gonorrhea have been detected in Europe.
Another public health concern is the scale at which chlamydia spreads in Sweden. Chlamydia is asymptomatic and when left untreated, can cause life-long health complications, such as infertility, pelvic inflammatory disease, and increased risk of contracting HIV.
In Sweden’s case, even though data collection improvements can explain why Sweden’s numbers can be at the top of STDs cases in Europe, this increase still warrants concern.
However, regarding the issue of sexual frequency in Europe the data is lacking. The paper ‘Sex Surveys in Europe: Reflections on over Four Decades of Sexual Behavior and Sexual Health Surveillance’ points out that despite the insight sexual behaviour can provide on socioeconomic disadvantage and the profound public health consequences of sexual behavior (STDs and unplanned pregnancy) funding can fall short and research can be limited by certain political affiliations who consider sexual behavior surveys as immoral:
“However, far right-wing and conservative politics are still threatening progress in sexual health and rights in some parts of Europe and globally”
When it comes to the decrease in sexual intercourse, the paper “Changes in Penile-Vaginal Intercourse Frequency and Sexual Repertoire from 2009 to 2018: Findings from the National Survey of Sexual Health Behavior” demonstrates that there has been a decrease in sexual frequency between 2009 to 2018 in the USA. Moreover, in this paper as well, the impact of moral judgements could also be influencing how surveys on sexual behaviours are shaped:
“The line between adolescence and adulthood has always been tenuous—perhaps particularly so when it comes to sexual behaviour—but we must continue to interrogate how declining adolescent sexual activity is in the “right direction” yet declining adult sexual activity warrants concern.”
As sexual behaviour and health are a multidimensional sphere, encompassing sociology, health, and psychology it remains difficult to measure. A survey done by Ispos in 2018 shows that people in Europe have a tendency to overestimate the frequency at which other people are being sexually active, and again, with the recent changes in morals and gender norms, new variables such as gender identity and how this can affect sexual practices have to be taken into account. When a sexual behaviour survey is being made, the survey's demographic can have a huge impact on its results.
Would it be a fair estimation to say that sexual frequency is declining globally? Not really. The existing data, available on datasets like WHO, Eurostats and NHWA, is scattered in terms of timeline, scale, and collection methods. Data on sexual health focuses far more on STDs and sexual assault however it is rarely correlated with sexual behaviour or fails to relate sexual behaviours with mental health. There are no similar studies at a European scale and therefore, while relevant to sexual behaviour studies do not give a clear explanation as to why STD rates are increasing. This alone could be due to a change in data collection rather than an increase of “reckless” sexual behaviours.
Regardless of these findings, this underlines the importance of data consistency and surveys of sexual behaviours to better understand the phenomenon faced during a public health crisis.
Ava Liange