Archive for Sexology

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5th Congress of the
Berlin, 29 June - 2 July 2000
"For a Millennium of Sexual Health"
Friday 30th June 2000

Global Sex: Sexuality and sexual practices around the world

Dr Judith Mackay

Senior Policy Advisor, TFI, World Health Organization

Professor Erwin J. Haeberle, Director, Archive of Sexology at the Robert Koch Institute, Berlin has, stated:

"Now that we have entered the age of economic globalization, it is becoming increasingly important for sexologists and other health professionals to take a global view of sexual health as well." [1]

This paper is divided into two components - firstly, the difficulties of global research on sex, and second, some of the findings.


Researching sex on a worldwide, comparable, basis -- as I have been doing for the last 5 years -- is not easy:

1. Very few sexology institutes or specialists exist in most countries, especially developing countries.

2. Only a handful of countries have comprehensive statistics.

3. There is no central depository for global sex data (in contrast to World Health Organization's databank of health statistics). For example, there are almost no archives of quantitative research on sexual practices; international sex- related legislation or regulations and enforcement; data on economic aspects of sex; public opinion surveys; or trends. There is not even a global coordinating organisation for sex counselling, which has further implications for definition of terms, ethical standards, and training.

4. Quantitative data seems particularly difficult to obtain; qualitative data, while valid, is less suitable for international comparative analyses.

5. Sex research, where it exists, is often fertility-related, rather than sex-orientated. The only almost-complete data-sets I could find were for pregnancy, infertility, contraception and AIDS and, to a lesser extent, legal minimum age of marriage, and divorce.

6. There has been a lack of standardisation of terms in many areas of sex research. For example, in the tobacco field, there are exact terms to define a smoker (daily smoker, aged 15 years and over), initially suggested by WHO and now used by all countries in the world. This enables comparable analysis.

7. Even definitions vary, e.g.:

a) "sex counselling" can be used for in-depth specific psycho-sexual counselling, while others use it when condoms are distributed.

b) "obscenity" is particularly difficult to define, as the concept varies from person to person, country to country, and from different times to times. This is reflected in the confusion of laws on obscenity, which in some countries are complaint-driven, or widely disregarded in others.

c) "normal sex": My initial definition was "Sex that does no harm" but that leaves some awkward questions, such as necrophilia and bestiality. My final definition of "normal sex" for the atlas was sex with "informed consent." This therefore excludes paedophilia as a child cannot give informed consent. It also exclude rape and other crimes of violence, and bestiality and necrophilia, as neither beast nor dead body can "consent."

d) "sex": Even the definition of "sex" causes confusion. In the USA in 1999, two thirds of respondents in a survey reported in the Journal of the American Medical Association believed that oral-genital contact did not constitute "having sex," and one in five thought the same about anal intercourse.[2]

8. Poor data are reported - although this is certainly not confined to the discipline of sexology. Some surveys, eg those on rarer problems, such as unconsummated marriages or uncommon sex problems, are justified in reporting small sample size surveys, but at the 14th World Congress of Sexology in 1999, studies from some parts of the world were reported with 8% response rates to surveys on 'the best sexual moment of my life,' or a sample of 100 persons being asked their opinion on infidelity.

9. Imprecise terms are used in data collection, for example, I came across terms for "40 years and above" which on questioning turned out to be 40-45 years. Studies conducted on only the sexually active have been reported as national surveys.

10. Even where laws exist, they may be widely disregarded, eg parental decisions can override the legal minimal age of marriage in many countries.

11. Internet research: There is now an impressive array of web sites with excellent information on sex. Many are linked to Dr Haeberle's Robert Koch Institute site at: content:

Why are quantitative data so important?

It is not possible to plan interventions unless basic data are available, for example, there is no point planning sex education at the age of 15 if many young people are having sex at 13 years of age. Health facilities for AIDS, pregnancy, contraception and many other topics can also only be planned on the basis of epidemiological information.


"After people are clothed and fed, then they think about sex."

-- K'ung Fu-Tzu (Confucius) 551-479 BC

Sex: this most universal experience comes complete with an array of international similarities and some surprising differences, from country to country; between different ages, genders and cultures; and from the intensely personal to the economic and political. This essentially private activity often raises public and legal issues, even invoking the death penalty.


60% of marriages are still arranged, in part or in whole.

In the US, 30% of men and 28% of women are celibate or have sex only a few times each year.

40% of sexually active 16-45 year old Germans admit to having been sexually unfaithful, compared with 50% of Americans, 42% of British, 40% of Mexicans, 36% of the French, and 22% of the Spanish.

The highest divorce rate is in Hungary, followed by the USA and the Central African Republic. The divorce rates in the US are about double those in the UK.

The percent of 16-45 year olds who always use a condom with a casual partner is 69% of the French, 56% of Americans, 48% of Italians, 40% of British, 36% of Spanish, 32% of Germans, albeit ahead of Canada and Poland at less than 25%. Thailand tops the charts at 82%

Repressive laws exist for many aspects of sex.

There are 8 countries with the death penalty for homosexuality: Afghanistan, Iran, Mauritania, Pakistan, Saudi Arabia, Sudan, United Arab Emirates, Yemen.

There are 4 countries with the death penalty for adultery: Iran, Pakistan, Saudi Arabia, and Yemen.

Religion has a profound impact on many aspects of sex, from masturbation, adultery and homosexuality to birth control and divorce. In the UK in 1995 the Church of England denied a homosexual the right to be godfather to his sister's son. In Brazil in 1996 a Catholic Bishop refused to marry a paraplegic man, because he would not be able to have sex and father children.

Half the world's STIs are in Asia. The shadow of AIDS will also fall most heavily across Asia, in part because of large population numbers.

It was surprisingly difficult to find cheerful aspects of sex. Most of what is measured is negative - teenage abortions, diseases, child prostitutes, harsh laws, sex crimes such as rape, harassment and stalking. Even the success of sex education is usually measured by the avoidance of unwanted pregnancies and STIs, not by whether children grow up to have a fulfilling sex life.

The USA is the world's leading producer and consumer of Internet pornography (73%).

Studies on pornography fail to consider all the variables. For example, the liberalization of pornography laws in the USA, UK, Australia, and the Scandinavian countries has been accompanied by a rise in the rates of reported rapes. But the rates of all violent crimes have increased and more women come forward to report rape, making it difficult to draw any firm conclusions.

Few studies differentiate between erotica, soft and hard porn, or take into account baseline norms. It is one thing to say that x percent of rapists read pornography before committing a rape, but that statistic is meaningless unless it is known how many non-rapists read the same kind of porn. Further studies are needed to assess the effect of the various types of pornography.

Sex is increasingly separated from reproduction, by test tube babies, surrogate mothers, and cloning. New technology will introduce undreamt of possibilities in the sexual arena. Thus, quite new areas of sex research will arise in the future, ideally with globally standardised research tools and protocols.


1. Haeberle E. Foreword, The Penguin Atlas of Human Sexual Behavior, by Dr Judith Mackay, Penguin, 2000.

2. Stephanie A. Sanders, June Machover Reinisch, "Would You Say You "Had Sex" If...?" January 20, 1999. Journal of the American Medical Association 1999;281. p 275-277.

3. See ref 1, also

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