Sexuality and sexual health: Public health issues throughout the life course

1. Résumé analytique

1.1. Contexte, publics et enjeux

This special issue is based on the CSF-2023 survey, a large-scale national telephone and online survey (21,259 respondents aged 15–89, covering mainland France and four overseas territories) designed to document practices, life trajectories, sexual health, violence and discrimination.  The articles are primarily aimed at 18–29-year-olds for sex education, sexually active people aged 18–89 for sexual dysfunction and sexualised consumption, women aged 25–65 for cervical cancer screening, and women aged 18–49 at risk of an unwanted pregnancy for contraception. The key issues are: the effective implementation of sex education in schools, the high prevalence of sexual health problems (often linked to age, health status and past experiences of violence), the spread of sexualised consumption beyond MSM alone, inequalities in screening linked to sexual orientation and violence, and a shift away from the pill towards a variety of methods, with a rise in non-medical methods among women in precarious situations. The editorial points out that these findings should inform the National Sexual Health Strategy (SNSS) for 2030 and the roll-out of the Regional Sexual Health Coordination Bodies (CoReSS).

1.2. Operational contributions for the field

This issue provides recent statistical data on the actual coverage of sex education, the range of topics covered (risks, consent, violence, pleasure), and their link to perceptions of the timing of first sexual intercourse, particularly among young women. It provides robust estimates of the prevalence of persistent sexual dysfunction causing distress, broken down by gender, age, health status and history of violence, thereby justifying its inclusion in primary care consultations. It describes the range of substances used in sexual contexts (alcohol, cannabis, poppers, cocaine, new synthetic drugs) and shows that their use is also prevalent among the general population, although it remains more common among men who have sex with men and women who have sex with women. Analysing inequalities in cervical cancer screening based on sexual practices and sexual violence enables targeted measures to be implemented for women who have sex with women, those who do not report having a sexual life, and victims of violence. Finally, the chapter on contraception sheds light on the decline in the use of the pill, the rise in the use of IUDs and so-called ‘natural’ methods, and reveals the impact of the trend towards de-medicalisation and social inequalities on contraceptive choices, offering suggestions for personalised support in sexual health.

2. Points clés du document 

1. Sexuality education: high coverage but incomplete, with persistent inequalities (pp. 250–257))

   Nearly 9 out of 10 young people aged 18–29 say they have attended at least one sex education session, mainly at secondary school, with half of those under 24 having attended several sessions. The topics of contraception and STIs are almost always covered, but those relating to consent, violence, pleasure and sexual orientation remain less common, although they are on the rise among younger people. Pupils who remain in private (often faith-based) schools report fewer sessions and fewer topics such as homosexuality or sexual violence.

2. Common sexual dysfunctions that are closely linked to age, general health and sexual violence (pp. 257–266)

   18.9% of men and 36.4% of women who have been sexually active in the past year report at least one sexual dysfunction that has persisted for six months, and 10.9% of men and 21.2% of women report a dysfunction that causes distress. These disorders increase with age, functional impairment, the presence of chronic diseases and urogenital conditions (in men), and are more common in women who have experienced sexual violence. More than half of those affected report a real impact on their sex lives, which makes a case for integrated care within primary care.

3. Sexualised drug use: minority but diverse practices, extending beyond chemsex among men who have sex with men (pp. 265–273)

   In the general population, the use of psychoactive substances in a sexual context remains uncommon, but alcohol and cannabis are the most commonly used substances, particularly among 18–29-year-olds. Among those who already use substances other than alcohol and cannabis, the prevalence of sexualised use is significantly higher, and this applies particularly to MSM and FSWs, though it is not limited to them. The authors highlight the diversity of profiles, the lack of data for certain populations, and the need for harm reduction policies tailored to different groups, including those outside the MSM community.

4. Cervical cancer screening: good overall coverage, but inequalities based on sexual practices and violence (pp. 274–280)
   More than 8 out of 10 women aged 25–65 report being up to date with their cervical cancer screening, but this coverage is lower among women who have sex with women, those who have experienced sexual violence, and those reporting no sexual activity. Certain sexual behaviours (oral-genital practices) are associated with a higher uptake of screening, highlighting the importance of integrating sexuality into prevention messages and into healthcare provider–patient interactions.

   Plus de 8 femmes de 25–65 ans sur 10 se déclarent à jour de leur dépistage du cancer du col, mais cette couverture est plus faible chez les femmes ayant des rapports avec des femmes, chez celles ayant subi des violences sexuelles, et chez celles déclarant une absence de vie sexuelle. Certains comportements sexuels (pratiques bucco-génitales) sont associés à un meilleur recours au dépistage, ce qui souligne l’importance d’intégrer la sexualité dans les messages de prévention et dans l’interaction soignant·e–patiente.

5. Contraception: declining use of the pill, rise of IUDs and non-medicalised methods, major social inequalities (pp. 281–292)
   Among the 4,416 women at risk of an unwanted pregnancy, IUDs (27.9%) now surpass the pill (26.8%), ahead of condoms (18.6%) and 'natural' methods (7.4%), while 9.1% report using no method at all. The absence of contraception is strongly linked to social precariousness and individual determinants of sexuality, in a context of growing distrust of hormonal methods and a desire for 'naturalness'. This diversification complicates strategies for preventing unwanted pregnancies, but also opens up the possibility of supporting women in making choices that are more aligned with their values, provided the most vulnerable are not left without a solution.

   Among the 4,416 women at risk of an unwanted pregnancy, the IUD (27.9%) is now more common than the pill (26.8%), ahead of condoms (18.6%) and ‘natural’ methods (7.4%), whilst 9.1% report using no method at all. The lack of contraception is strongly linked to social vulnerability and individual determinants of sexuality, against a backdrop of growing mistrust of hormonal methods and a quest for ‘natural’ approaches. This diversity complicates strategies for preventing unwanted pregnancies, but it also opens up the possibility of supporting women in making choices that are more in line with their values, provided that the most vulnerable are not left without options.

3. Action pathways for local stakeholders 

1. Build a continuum of sex education from primary school to upper secondary, targeting 'blind spots' (pp. 250–257)
   At territorial level, establish a multi-year EARS (affective, relational and sexual education) calendar that systematically includes the themes of consent, gender-based and sexual violence, LGBTphobia, pleasure and desire — and not only biomedical risks. Prioritise under-served secondary and upper secondary schools, particularly private fee-paying schools, drawing on UNESCO national recommendations and the Ministry's frameworks.

   Establish, at a regional level, a multi-year curriculum for EARS (education on emotional, relational and sexual health) that systematically covers the topics of consent, gender-based and sexual violence, LGBTphobia, pleasure and desire, and not just biomedical risks. Prioritise secondary schools with low coverage, particularly state-funded private schools, in line with UNESCO’s national recommendations and the Ministry’s guidelines.

2. Systematically integrate sexual health and dysfunctions into primary care consultations (pp. 257–266)
   Train GPs, midwives, advanced practice nurses and sexual health centre teams to use standardised questioning on desire, pleasure, pain, erection, orgasm and associated distress, particularly in older people, those with chronic illnesses or functional impairments. Build coordinated care pathways (general medicine, sexology, gynaecology, urology, psychology) with identification and management of sexual violence incorporated into local protocols.

   To train general practitioners, midwives, advanced practice nurses and sexual health centre teams to ask standardised questions about desire, pleasure, pain, erection, orgasm and associated distress, particularly among older people and those with chronic conditions or functional impairments. Developing coordinated care pathways (general practice, sexology, gynaecology, urology, psychology) that include the identification and management of sexual violence within local protocols.

3. Develop harm reduction measures for sexualised substance use, beyond MSM (pp. 265–273)
   Adapt existing services (CAARUD, CSAPA, CeGIDD, sexual health centres) to offer specific consultations on sexualised substance use for MSM, but also for WSW and the general population using cocaine, poppers or new synthetic drugs in sexual contexts. Co-produce educational resources (workshops, online tools, therapeutic patient education messages) that address infectious risks (HIV, HCV, STIs), cardiovascular and psychological risks, and harm reduction strategies (dosing, routes of administration, consent under the influence of substances).

   Adapt existing services (CAARUDs, CSAPAs, CeGIDDs, sexual health centres) to offer specific consultations on substance use in sexual contexts for MSM, as well as for women who have sex with women and the general population who use cocaine, poppers or new synthetic substances in a sexual context. To jointly develop educational materials (workshops, online tools, text messages) that address infectious risks (HIV, HCV, STIs), cardiovascular risks and mental health risks, as well as harm reduction strategies (dosage, methods of administration, consent whilst under the influence of substances).

4. Target cervical cancer screening inequalities among WSW, victims of violence and women reporting no sexual activity (pp. 274–280)
   Working with multi-professional health centres, maternal and child health services and sexual health centres, set up dedicated campaigns and consultations for women who have sex with women, incorporating explicit messages: HPV risk and the value of screening regardless of partner type. Develop adapted screening modalities for women who have experienced sexual violence (choice of healthcare professional, self-sampling, extended appointment times), and do not exclude from screening women with no recent sexual activity but who were previously exposed.

   Work with multi-disciplinary health centres, maternal and child health services and sexual health centres to organise campaigns and consultations specifically for women who have sex with women, incorporating clear messages about the risk of HPV and the importance of screening, regardless of the type of partner. Develop appropriate screening methods for women who have experienced sexual violence (choice of healthcare professional, self-sampling, extended timeframe), and do not exclude from screening women who are not currently sexually active but were previously exposed.

5. Rethink contraceptive support from a perspective of managed de-medicalisation and social equity (pp. 281–292)
   Develop contraceptive counselling pathways that take into account criticisms of hormonal methods, aspirations towards 'natural' methods and ecological considerations, while providing accurate information on the effectiveness and risks of each method. Develop free or low-cost options for IUDs, implants and emergency contraception for women in precarious situations and migrant women, and train social and medico-social professionals to identify situations where no contraception is being used.

   To develop contraceptive guidance pathways that take into account criticisms of hormonal methods, the desire for ‘natural’ methods, and environmental concerns, whilst providing accurate information on the effectiveness and risks of each method. Develop free or low-cost provision of IUDs, implants and emergency contraception for women in vulnerable situations and migrant women, and train social and healthcare professionals to identify cases where contraception is not being used.

4. Additional references 

🔍➕ For more information, see the articles referenced by "Pratiques en Santé" on the theme of affective and sexual education ➡️🔗https://pratiquesensante.odoo.com/4-1-education-affective-sexuelle

5. Frequently asked questions 

1. What is the current reality of sex education in schools? (pp. 250–257)
   The majority of 18–29-year-olds report having attended at least one sex education session, mainly at secondary school, but fewer than half have attended sessions across several school cycles (primary, secondary, upper secondary), and upper secondary remains particularly under-covered.

   The majority of 18–29-year-olds say they have received at least one session of sex education, mainly at secondary school, but fewer than half have received sessions across multiple stages (primary, secondary, and sixth form), and sixth form remains particularly underserved.

2. Do sex education sessions have an impact on young people's experience of their first sexual encounter? (pp. 253–256)
   Among young women, those who have attended at least one sex education session more often report that their first sexual encounter took place at the 'right time', whereas nearly half of those who have never attended a session would have preferred it to have happened later.

   Among young women, those who have attended at least one sex education session are more likely to say that their first sexual encounter took place at the ‘right time’, whereas nearly half of those who have never attended such a session would have preferred it to have happened later.

3. What proportion of the population is affected by significant sexual dysfunctions? (pp. 257–263)
   Approximately 1 in 5 men and more than 1 in 3 women report at least one persistent sexual disorder, and more than half of those affected report an impact on their sex life, which represents 10.9% of men and 21.2% of women.

   Around 1 in 5 men and more than 1 in 3 women report at least one persistent sexual dysfunction, and more than half of those affected say their sex life has been affected; this represents 10.9% of men and 21.2% of women.

4. What are the main factors associated with sexual dysfunctions? (pp. 260–263)
   Ageing, the presence of chronic illnesses or functional impairment, urogenital conditions (in men), and a history of sexual violence (particularly in women) significantly increase the likelihood of persistent disorders causing distress.

   Advancing age, the presence of chronic conditions or functional impairment, urogenital conditions (in men), and a history of sexual abuse (particularly in women) significantly increase the likelihood of persistent problems that cause distress.

5. Is sexualised substance use limited to MSM? (pp. 265–273)
   No. Even though MSM and WSW more often report these practices, the survey shows that the use of alcohol, cannabis, cocaine, poppers or new synthetic drugs in a sexual context exists across the general population who have ever had sex, albeit at minority levels.

   No, although MSM and FSF report these practices more frequently, the survey shows that the use of alcohol, cannabis, cocaine, poppers or new synthetic drugs in a sexual context is found across the entire population who have ever had sex, albeit at a minority level.

6. Which women are less likely to be screened for cervical cancer? (pp. 274–280)
   Women who have sex with women, those who have experienced sexual violence and those reporting no sexual activity are less often up to date with their screening, despite good overall coverage.

   Women who have sex with women, those who have experienced sexual violence, and those who report having no sex life are less likely to be up to date with their screening, despite good overall coverage.

7. How are contraceptive practices evolving and for which populations? (pp. 281–292)
   IUDs and progestogen-only methods are gaining ground, the pill is declining, and natural methods and non-use more frequently affect women living in precarious situations, in a context of distrust towards medicalisation and a search for 'naturalness'.

   The IUD and progestogen-only methods are gaining ground, the pill is losing ground, whilst natural methods and non-use are more common among women in precarious situations, against a backdrop of mistrust of medicalisation and a search for ‘naturalness’.

6. Easy-Read Version 

6.1. Easy-Read Summary

Title: Sexuality and sexual health in France

• This document is about sexuality in France.

• It explains how people learn about sexuality, protect themselves and experience their sexuality.

• It also looks at sexual problems, violence and inequalities.

What the document provides

• It provides recent, reliable figures on sexuality and sexual health.

• It shows which groups receive less information, care and screening.

• It helps professionals to better adapt their actions in the field.

6.2. Easy-Read Key Points

1. Sex education at school

• Most young people have had at least one session at school.

• This is mainly at secondary school, less so at upper secondary and primary.

• The focus is mainly on risks, not enough on consent and pleasure.

2. Common sexual problems

• Many men and women have persistent sexual problems.

• These problems increase with age or illness.

• Women who are victims of violence have more sexual difficulties.

3. Substances and sexuality

• Some people take alcohol or other substances for sex.

• This is more common among MSM and WSW, but not only them.

• These practices can increase health risks.

4. Cervical cancer screening

• Many women are up to date with their screening.

• Women who have sex with women are less likely to be screened.

• Women who are victims of violence are also less likely to be screened.

5. Changing contraception

• The pill is used less, the IUD is used more.

• Some women choose so-called 'natural' methods.

• Women in precarious situations more often have little or no contraception.

7. Cross-cutting analysis – Pratiques en Santé values

• Health literacy: The document remains technical, but methodological boxes and bilingual summaries facilitate appropriation by professionals with a high level of health literacy; it is not suitable as it stands for audiences with comprehension difficulties.

• Empowerment: The analyses highlight subjective perception (the 'right time' for first intercourse, distress linked to sexual disorders), which opens the way to approaches grounded in people's own perspectives, but few concrete co-construction tools are described.

• Participation: The CSF-2023 survey is based on participation from the general population but does not describe co-construction mechanisms with beneficiaries in the design of activities; participation is primarily statistical.

• Community health: The articles identify groups (MSM, WSW, women who are victims of violence, people with chronic illnesses) but do not detail structured community approaches; the collective dimension remains implicit.

• Ethics: The survey protocols include strong safeguards (CNIL opinion, CPP, ethics committees, referral procedures in cases of disclosed violence), demonstrating a high level of ethical vigilance.

• Human rights: The analyses incorporate questions of gender equality, sexual orientation, violence and precariousness, in keeping with a rights-based approach (equitable access to education, screening and contraception).

• Intersectorality: The editorial and the articles link health, national education, policies to combat violence, addiction services and the SNSS, thereby encouraging intersectoral strategies.

• Partnership: The CSF-2023 is led by Inserm, ANRS-MIE, Santé publique France and other partners, but operational partnership models in the field are not detailed.

• Anti-discrimination: The document records the effects of LGBTphobia, gender-based and sexual violence and precariousness on sexual health, without however proposing standardised anti-discrimination tools; it nonetheless provides strong arguments for advocacy.

8. Assessment of resource reliability

• Scientific relevance

  • Large-scale survey (more than 21,000 respondents, telephone + online protocol, biological self-sampling for certain modules), with rigorous statistical weighting and analyses (Chi-square tests, logistic regressions, 95% CIs, p-values).

  • Robust ethical and regulatory framework (CNIL, CPP, Inserm ethics committees) and up-to-date bibliographic references (up to 2025 for some aspects such as chemsex, sex education and contraception).

  • Published in the Bulletin épidémiologique hebdomadaire (the institutional peer-reviewed journal of Santé publique France).

• Operational relevance

  • Indicators immediately available for territorial diagnosis: prevalence of sex education sessions, of sexual dysfunctions, of sexualised substance use, of screening uptake and of contraceptive practices.

  • Ability to support local action plans (CoReSS, Local Health Contracts, regional contraception access programmes, EARS campaigns) and to target specific groups (WSW, MSM, women who are victims of violence, older people with chronic illnesses).