Improving sexual and reproductive health is a public health priority, and the timing of first sexual intercourse and the context in which it occurs both have health implications. Moreover, information and monitoring about sexual behavior is essential to the design and assessment of interventions to improve sexual health. The last survey centered on the sexual and reproductive health of adolescents/young adults in Switzerland was carried out in 1995. Since then, all data on the subject come from general surveys. As contextual factors, the life contexts of youths explain a large amount of the variance in sex related behaviors, and a fair amount of new developments have appeared in the last twenty years that might have had an impact on youth’s sexual behavior: AIDS has gone from a fatal to a chronic condition, there has been a liberalization of the access to emergency contraception, Swiss law changed in 2002 and allowed abortion in the first 12 weeks of pregnancy, the HPV vaccine is recommended as part of the vaccination program (for girls since 2008 and for boys since 2016), sildenafil citrate (e.g. Viagra®) has appeared on the market as a treatment for erectile dysfunction, pornography has become extremely accessible and free, phenomena of online sex and sexting have emerged. These changes might have an impact on adolescent sexual behaviors although we do not know how and to what extent. This survey provides self-reported information from young adults in Switzerland. The primary objective was to obtain current epidemiological data on young people’s sexual and reproductive health and behaviors.
The survey comprised three parts: two of them contained questions on socio-demographic characteristics of the participants (part 1) and on their sexual and health behavior (part 3), and one part was a life history calendar (LHC, part 2). In the LHC, participants were asked to identify the period of occurrence of different life events. The aim of the LHC was to facilitate recollection and dating of personal events by referencing each of them to other key events or milestones of their life (e.g. moving to a new residence or obtaining one’s drive licence). The initial sample was provided by the Swiss Federal Office of Statistics, and it was representative of the entire population living in Switzerland in terms of sex, language, and canton of residence. This sample included 49’798 individuals aged between 24 and 26 years old on 30 September 2016 (birthdate between 01 October 1989 and 30 September 1992). Starting on the 8th June 2017, a first invitation letter was sent to 10’000 individuals. To ensure the operation of the server and allow adjustments in case of problems, the remaining letters (39’798) were sent in two different waves (9 June and 30 June). Depending on the canton of residence, the letter was sent either in French and German, or in Italian and German. The initial goal was to obtain 10’000 answers, but it rapidly appeared that respondents were more reluctant than anticipated to participate in the survey. Moreover 2’402 (4.8%) letters were returned by the postal service, 12 (0.02%) e-mails were sent by parents or caregivers to inform that the person was disabled, had gone abroad or did not speak one of the three languages and 16 (0.03%) letters were returned by participants themselves to say that they did not want to participate. In September 2017, it was decided to send a reminder to 10’000 people randomly chosen among the ones having not answered yet and not being part of the returned letters. Data collection ended on 26 November 2017. The final sample included 7’142 people aged between 24 and 26 years and living in Switzerland at the time of the addresses delivery (30 September 2016). This corresponds to a response rate of 15.1%. Among them 5’618 individuals completed the entire questionnaire or a significant part of it (11.9%, or 78.7% of all respondents). After computing the distribution of the main socio-demographic variables available in the survey and for which the true population-level distribution was known, we had to correct the sample distribution using weights for two characteristics: sex and canton of residence because females from the French part of Switzerland were overrepresented in the participants. Weights were computed for those who abandoned during the third part of the questionnaire and those who completed it until the end (even if they omitted some questions).
Overall 94% of females and 89% of males had ever been in a steady relationship. Around three out of every four participants were currently in one such relationship. The great majority (95%) of respondents had ever had sexual partners, most of them between 2 and 7. About 5% had never had a sexual partner. Most (94%) had also had had sexual partners in the past 12 months, but in this case it was mainly only one. Over 70% of males and females had ever had casual sexual partners, but the percentage decreased to around only one quarter in the last 30 days. The majority of respondents (86%) had only had heterosexual contacts, however 15% of females and 13% of males had either homosexual or bisexual experiences. The mean age at first sexual contact was just under 17 years. Almost all respondents (96%) had ever had oral sex, most of them with an opposite-sex partner. The vast majority (95%) had had vaginal sex and half of respondents had it at least weekly. The same percentage of females and males (49%) reported ever having had anal intercourse. Participants reporting having had sex with multiple partners at the same time, using medication to enhance sexual performance, or being blackmailed were a small minority. Those having ever had intercourse with someone met on the Internet accounted for 22% of females and 35% of males. More than half of males (56%) and 46% of females had ever had intercourse while intoxicated. Eleven percent of females had ever been pregnant and 8% of males declared ever having had a partner pregnant. Among females, the pregnancy was mainly continued (57.6%) and in almost 30% of the cases interrupted. Among males, pregnancy was continued in 49% of cases and interrupted in 42% of them. An important percentage (45%) of youths had ever had HIV testing, with females slightly outnumbering males. Almost all reported a negative result. Close to one youth in 10 reported ever having had a diagnosed sexually transmitted infection. Chlamydia was the most commonly reported among females and males. The vast majority (93%) of respondents had used some kind of contraception / protection at their first intercourse, mainly male condoms. However, at last intercourse contraception / protection methods were more equally distributed between male condom and contraceptive pill. All other contraception methods represented less than 5%, with the exception of intrauterine device (IUD) and vaginal ring. Around 90% of both males and females reported being only or strongly attracted to people of the opposite sex, and males (4.6%) outnumbered females (1.8%) in reporting same sex attraction. It is worth noting that 0.6% of females and 0.4% of males declared not feeling attracted to anyone. The vast majority of participants (92%) described themselves as heterosexuals, around 6% homosexuals or bisexuals, slightly under 2% did not know and 0.6% indicated the option other. About one female in nine reported a sexual dysfunction. Among males, 17.5% indicated premature ejaculation and the same percentage erectile dysfunction, although only 0.6% declared it to be moderate or severe. There was an important difference in lifetime unwanted sexual experiences and in having ever been victim of sexual assault or abuse between females and males, with females largely outnumbering males. Two females out of every 5 (40%) and 8% of males had received the HPV vaccine. However, it is worth noting that half of males and over one-fifth of females did not know whether they had been vaccinated. Almost half of females had ever used emergency contraception and close to two-fifths of males reported their partner having ever used it. Respondents indicating that they (or their partner) used emergency contraception as their main contraception method were very few. Males outnumbered females in online sexual activity. Almost 3 out of 4 reported having already sent a sexy text-only message without photo, a sexy photo and / or a video of themselves. On the other end, almost 80% of participants had already received such messages. There were no gender differences for these two actions. However, 22% reported having already forwarded such messages to other persons without consent. In this case, males were overrepresented. 1 SUMMARY 12 RAISONS DE SANTÉ 291 Males were slightly more likely than females to have received something or obtained an advantage in exchange of sexual intercourse, but it remained a small minority. On the contrary, males clearly outnumbered females in ever giving something or offering an advantage in exchange of sexual intercourse.
Overall, youth in Switzerland report a healthy sexuality. However, young people being active on online sex need to be further analyzed regarding both the frequency of this practice and the potential risk they incur in. Unfortunately, women continue to be overrepresented in the cases of unwanted sexual experiences and sexual abuse. Contrary to popular belief, sexual dysfunctions are relatively common among young people. There is a sizeable percentage of youth who have exchanged sexual favors for money, goods or services, who have had sexual relationships while intoxicated or group sex. Reliable contraceptive / protective use is the norm in this age group and it varies from first to last intercourse. Male condom and hormonal contraception are the most used by far. Emergency contraception is a clear option in cases when the main contraceptive method failed. However, even if the condom use rate is quite high, even at last intercourse, the reported STI rate of 10% is relatively high compared to other studies and needs further analysis.