A recent study assessing sexual well-being in the United States suggests that while many people report positive and desired sexual experiences, significant gaps remain in testing, communication, and overall satisfaction. Published in Sex & Couple Therapy Journalthe findings show evidence of persistent gender disparities and widespread lack of access to preventive care. These insights highlight the need for a more comprehensive approach to reproductive and sexual well-being across the country.
Public health efforts in the United States have traditionally approached sexual health through narrow categories. Government and state programs tend to focus on preventing specific diseases and managing family planning. This piecemeal approach often ignores the holistic nature of sexual well-being.
Scientists wanted to assess the country using a broader, more integrated framework. Recent changes in the legal landscape, including restrictions on access to abortion and reproductive health care, are creating new challenges for public health.
“I’ve spent much of my career thinking about how to measure sexual health in meaningful ways,” Jesse Ford, an assistant professor in the Department of Social Medicine at Columbia University, told SciPost. “Since around 2010, my work has focused on developing and refining approaches that go beyond illness to capture aspects such as joy, satisfaction, and communication.”
To collect more comprehensive data, researchers used the World Health Organization’s Practice and Experience Sexual Health Assessment Survey. This standardized questionnaire assesses knowledge, behaviors, and health outcomes across diverse populations worldwide. Scientists selected specific indicators from this tool and supplemented them with two additional questions from a federal survey on communication comfort.
“More recently, I attended several conferences where the World Health Organization introduced the SHAPE survey, a new tool designed to assess sexual health across diverse global contexts,” Ford explained. “I was really struck by its potential to capture a more holistic picture of sexual well-being.”
The team conducted an online survey through a market research company in July 2024. They recruited a sample of 2,555 English-speaking adults living in the United States between the ages of 18 and 94.
“So when the opportunity arose to conduct the SHAPE study with colleagues in the United States, I was eager to participate,” Ford said. “This felt like a unique opportunity to gain a deeper understanding of what sexual health looks like in real life and what the results reveal about both progress and ongoing gaps.”
To ensure data quality, the recruitment platform used fraud detection tools to filter out autoresponders and duplicate accounts. The final group included more women than men, with 56 percent identifying as women and 43 percent as men. Approximately 71 percent of participants identified as heterosexual.
When examining survey responses, researchers found that sexual contact was generally consensual and physically rewarding. Approximately 89% of participants reported their most recent sexual experience as desired. About 87% reported that their last sexual experience was pleasurable.
Despite these positive reports, overall satisfaction was moderate. Only 56% of the sample said they were satisfied with their sex life over the past year.
“We noticed that there was some sort of disconnect throughout the data,” Ford said. “For recent sexual encounters, people reported very high levels of desire (89%) and pleasure (87%). But when asked more broadly about sexual satisfaction over the past year, that dropped to 56%.”
This contradiction suggests that individual encounters do not necessarily lead to long-term fulfillment. “That gap raises a lot of interesting questions,” Ford added. “This suggests that while individual sexual experiences may often be positive, people as a whole may not be having the sex life they would like. Are people not having sex as often as they would like? Are there unmet desires or relationship constraints? Are people having pleasurable encounters, but lack consistency, connection, and fulfillment over time?”
The study also found evidence of significant gaps in preventive care and routine testing. Just 50% of the participants had never been tested for human immunodeficiency virus, commonly known as HIV. Additionally, 47% had never been tested for other sexually transmitted infections.
The data revealed differences based on gender identity. Women and people with other gender identities reported lower rates of pleasure compared to men. These same groups also reported higher lifetime exposure to sexual violence.
“First, the disparities between gender-diverse individuals were even more pronounced than I expected,” Ford said. “This group showed many of the indicators we typically associate with strong sexual health, such as increased comfort communicating with partners, more progressive attitudes, and higher levels of sexual health knowledge. However, they reported worse outcomes in several areas, including lower sexual satisfaction, lower rates of sexually transmitted infection and HIV testing, lower feelings of safety, and increased exposure to sexual violence.”
This contrast suggests that progressive attitudes and open communication alone are not sufficient to protect marginalized groups. “This contrast highlights that knowledge and openness alone cannot protect; there are deeper structural vulnerabilities that require a more coordinated and affirmative response,” Ford explained.
When it comes to communicating about sexual health, opinions were divided depending on who you were talking to. Almost half of respondents felt completely comfortable discussing sexual health with their partner, but only 31% felt comfortable having a similar conversation with their health care provider.
“One of the key lessons is that sexual health in the United States is characterized by both real progress and deep gaps. It often feels like we’re taking one step forward and two steps back,” Ford said. “On the positive side, many people report that sex is desirable and enjoyable, and there are signs of cultural change, such as an increased ease in talking about sexual health with partners and increased acceptance of same-sex relationships. These are meaningful indicators of progress.”
However, significant challenges remain. “At the same time, the gap is significant,” she continued. “Women and gender diverse individuals continue to report decreased pleasure, increased exposure to sexual violence, and decreased safety. We also find relatively low levels of communication with health care providers, and many have never been tested for HIV or other sexually transmitted infections. High rates of unintended and adolescent pregnancies further demonstrate ongoing structural and educational challenges.”
The researchers noted several limitations to consider when interpreting these numbers. The study relied on self-reported data collected from an online opt-in panel. This means that participants actively chose to participate in the research platform.
“Because this was a cross-sectional online study, we cannot make causal claims as to why these patterns exist,” Ford explained. “The data provides a snapshot in time rather than an indication of how sexual health changes over time.”
The demographic composition of the sample is not completely representative of the broader population. “While the sample included a wide range of ages and diverse participants, it is not completely representative of the U.S. population,” Ford said. “People who choose to participate in online surveys about sexual health may differ in important ways, including their comfort level discussing these topics.”
The research team also did not use statistical methods to exclude other variables that might explain gender differences. For example, they did not use regression analysis, a statistical technique that helps scientists determine how strongly different factors influence a particular outcome.
“As a result, the sex differences we report should be interpreted as descriptive patterns rather than causal relationships or fully explained disparities,” Ford noted.
She also warned that measures such as “desired” sex could be interpreted differently by different people. “Another point is that measures such as ‘wanted’ sex and pleasure can be interpreted differently by participants,” Ford said. “I argue that the coexistence of high wantedness and reporting of negative or non-consensual experiences should not be seen as contradictory, but rather as a reflection of the complexity of how people understand and report their experiences.”
Looking ahead, scientists suggest that establishing a coordinated national strategy could help address the persistent inequalities uncovered in the study.
“Long term, I hope that sexual health will be treated as a core public health priority in the United States,” Ford told SciPost. “One of our goals is to work with agencies like the Centers for Disease Control and Prevention and other national surveillance systems to develop an annual ‘scorecard’ on sexual health that will track our progress in a transparent and engaging way and motivate us as a nation to do better.”
“More broadly, this research ties into the need for a coordinated U.S. National Sexual Health Strategy that moves beyond a narrow focus on disease and instead emphasizes agency, consent, pleasure, and healthy relationships across the life course,” she concluded. “Even in a challenging political climate, building better data systems and a more comprehensive approach to sexual health is essential to improving outcomes, especially for marginalized communities.”
The study, “The State of Sexual Health in the United States in 2024: Results from the World Health Organization Sexual Health Survey (SHAPE),” was authored by Jesse V. Ford, Eli Coleman, Leonor de Oliveira, Ryan L. Rahm-Knigge, and Kristen P. Mark.
