Behind Closed Doors: Americans and Sex

By: Jennifer Wider, MD
November 17, 2010

A recent study conducted by sexual health researchers at Indiana University challenges some of the myths about sexual practices among adolescents and adults in this country. The National Survey of Sexual Health and Behavior (NSSHB), which was published in the Journal of Sexual Medicine, is the largest, most comprehensive survey of American’s sexual behavior since 1994.

The study includes information from roughly 6,000 American participants, ranging in age from 14-94. Among other things, the study reveals patterns of condom use, same-sex encounters, sexually-transmitted diseases and sexual behavior among men and women.

One of the more surprising findings involved condom use. Adolescents between the ages of 14-17 reported high rates of protected sex. “Our data show that, in fact, the majority of adolescents are using condoms,” said Dennis Fortenberry, MD, MS, professor of Pediatrics in the Indiana University School of Medicine, who led the adolescent section of the survey. The same did not hold true for older adults. “The proportion of older adults using condoms, however, is much smaller.”

This finding was worrisome for the researchers because it poses an increase in risk of disease among an aging population who report multiple sexual partners. And although this age group may not be as concerned about pregnancy, the finding suggests that sexually transmitted disease education and prevention efforts may need to be increased for this population.

“One reason condom use remains low is that misconceptions about condoms are common. For example, many people justify condom non-use by saying that condoms interfere with sexual pleasure,” said Fortenberry. “However, among adults, ratings of sexual pleasure at last intercourse were no different among those using condoms as compared to those not using condoms. We think this means that health care providers and health educators should be more assertive about the idea that condoms do not detract from the quality of sexual experiences.”

There were some similarities in condom use among adolescents and adults; however, “For both adolescents and adults the relationship context in which sex occurs influences the use. Condom use is much higher for less involved and shorter relationships, and is much lower in longer term relationships,” said Fortenberry.

There were some notable gender differences as well:

  • Men were more likely to achieve an orgasm when vaginal intercourse was involved, while women were more likely to experience orgasm when they engaged in a variety of acts, including oral sex.
  • 85% of men reported that their latest sexual partner climaxed during sexual intercourse, while only 64% of women reported having an orgasm during their latest sexual encounter.
  • Roughly 33% of women reported feeling pain during intercourse, compared with only 5% of men.
  • Roughly 7% of adult women and 8% of men identify themselves as gay, lesbian or bisexual. The proportion of participants who reported same-gender sex at some point in their lives was higher among men.

The study revealed a wide variety of sexual experiences among American adults. The number of adults engaging in just one sex act per encounter has gone down over the years. And while vaginal intercourse is still the most common sexual behavior in the United States, many sexual experiences do not involve intercourse, but instead involve partnered masturbation or oral sex.

Maintaining an active and healthy sex life is part of overall total body health. And this recent study highlights the importance of sexual health and education. “Perhaps the most important point is the presence and importance of sex and sexuality throughout the lifespan” said Fortenberry. “Data like those in our study confirm and extend findings of others and give us the empirical basis for continued commitment to sexual health, with education, public dialogue and access to sexual health services as the most important outcome of the work.”


For more information on the Society for Women’s Health Research please contact Rachel Griffith at 202-496-5001 or

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