U.S. Sexual Health Report Card: High Pleasure, Low Testing, Stark Gender Disparities

A new sexual health survey reveals a mix of progress and persistent gaps. Overall, many Americans report positive experiences—interest in having sex, sexual pleasure, and good communication with partners—yet women and gender-diverse individuals still face higher rates of sexual violence, lower sexual pleasure, and discomfort discussing sexual health.

The new study was led by Jessie Ford, PhD, assistant professor of sociomedical sciences at Columbia University Mailman School of Public Health, and the findings are published in the Journal of Sex & Marital Therapy.

Ford and her collaborators conducted a cross-sectional online survey in the U.S. using the World Health Organization’s Sexual Health Assessment of Practices and Experiences (SHAPE) questionnaire. The study included 2555 adults aged 18 to 94.

• Participants reported high sexual wantedness (89%) and pleasure (87%) during the most recent sexual encounter but moderate overall satisfaction (56%).
• Gender differences emerged: women and gender-diverse participants reported lower pleasure, higher sexual violence exposure, and reduced safety in public spaces compared to men.
• Sexual health communication was more common with partners (49%) than with health care providers (31%).
• Testing for HIV and other STIs was suboptimal, with 50 percent and 47 percent of participants never tested, respectively.
• Adverse outcomes included self-reported unintended pregnancy (40%), adolescent pregnancy (19%), and HIV prevalence (3%). 
• Participants largely supported same-sex relationships (71%, up from 66-69% in national estimates), 25% rejected traditional gender norms around sexual needs (versus 40% previously), and 48% supported abortion rights (versus 40%).

“Despite growing awareness of consent and people’s increased willingness to discuss negative sexual experiences, the disconnect between public health goals and lived realities remains stark, underscored by low STI and HIV testing rates, high unintended pregnancy, and discomfort discussing sexual health with providers,” says Ford.

“The apparent contradiction between high rates of ‘wanted’ sex and continued reports of non-consensual experiences suggests a growing public awareness of sexual consent and a decline in stigma—an encouraging signal of cultural change,” she adds.

Establish a National Sexual Health Strategy

Much like existing national plans for HIV or mental health, the authors argue for a national sexual health strategy that would promote awareness, invest in research, and emphasize a positive, holistic approach to sexual well-being—shifting the focus from disease avoidance to one of agency, consent, pleasure, and healthy relationships across the life-course.

“We recognize that achieving this goals in today’s political environment is challenging. Funding for sexual and reproductive health has been reduced in many areas, access to abortion and gender-affirming care is increasingly restricted, and broader anti-rights movements—including intensified debates over sex education, contraception, and LGBTQ+ inclusion—pose significant barriers. Even so, these objectives remain important and valid,” Ford says.

Background on Jessie Ford

Jessie Ford is a sociologist whose research explores how expectations and inequalities around gender and sexuality shape sexual health, violence, and pleasure. She is a leading proponent of sex-positive epidemiology that considers and incorporates pleasure, satisfaction, and well-being alongside familiar outcomes such as sexually transmitted infections. To this end, she has introduced a set of indicators to assess broad progress in sexual health outcomes with a positive, holistic focus on sexual health. Last year, she participated in the inaugural World Sexual Health Assembly. Recently, she published research on young men’s views on consent.

Additional study authors include Eli Coleman, Leonor de Oliveira, Ryan L. Rahm-Knigge, and Kristen P. Mark at the University of Minnesota Twin Cities.

No potential conflict of interest was reported by the authors.

Funding for this study was supported by the senior author’s internal university funds and by a National Institute of Alcohol Abuse and Alcoholism grant (AA028532).