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Changes in, and factors associated with, frequency of sex in Britain: evidence from three National Surveys of Sexual Attitudes and Lifestyles (Natsal)

BMJ 2019; 365 doi: (Published 07 May 2019) Cite this as: BMJ 2019;365:l1525

Linked Editorial

Surveys indicate a decline in sex among young adults in Britain

Linked Opinion

Let’s talk about sex

  1. Kaye Wellings, professor1,
  2. Melissa J Palmer, research fellow2,
  3. Kazuyo Machiyama, assistant professor2,
  4. Emma Slaymaker, associate professor2
  1. 1Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
  2. 2Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to: K Wellings kaye.wellings{at}
  2. Accepted: 19 March 2019


Objectives To examine changes over time in the reported frequency of occurrence of sex and associations between sexual frequency and selected variables.

Design Repeat, cross sectional, population based National Surveys of Sexual Attitudes and Lifestyles (Natsal-1, Natsal-2, and Natsal-3).

Setting British general population.

Participants 18 876 men and women aged 16-59 and resident in Britain were interviewed in Natsal-1, completed in 1991; 11 161 aged 16-44 years in Natsal-2, completed in 2001, and 15 162 aged 16-74 years in Natsal-3, completed in 2012. Comparisons of actual and preferred sexual frequency in men and women aged 16-44 (the age range common to all surveys) between the three surveys. Factors associated with sexual frequency of at least once a week were examined using Natsal-3 data.

Main outcome measures Sexual activity in the past month; frequency of sex in the past month; preferred frequency of sex.

Results Median number of occasions of sex in the past month was four in Natsal-1 and Natsal-2 and three in Natsal-3 among women; and three in Natsal-1, Natsal-2, and Natsal-3 among men. The proportion reporting no sex in the past month fell between Natsal-1 and Natsal-2 (from 28.5% to 23.0% in women and from 30.9% to 26.0% in men) but increased significantly in Natsal-3 (to 29.3% in women and 29.2% in men). The proportion reporting sex 10 times or more in the past month increased between Natsal-1 and Natsal-2, from 18.4% to 20.6% in women and from 19.9% to 20.2% in men, but fell in Natsal-3, to 13.2% in woman and 14.4% in men. Participants aged 25 and over, and those married or cohabiting, experienced the steepest declines in sexual frequency (P values for interaction <0.05). Alongside the declines in sexual frequency, there was an increase in the proportion reporting that they would prefer sex more often. Age adjusted odds ratios showed that men and women in better physical and mental health had sex more frequently, as did those who were fully employed and those with higher earnings.

Conclusions Frequency of sex has declined recently in Britain, more markedly among those in early middle age and those who are married or cohabiting. The findings and their implications need to be explained in the context of technological, demographic, and social change in Britain and warrant further investigation.


  • Contributors: KW contributed to the planning, conduct, and reporting of the work described in the article and is responsible for the overall content. As guarantor, she accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. KW participated in the design and implementation of all three Natsal studies and prepared the first draft of the paper with contributions from MP, KM, and ES. MP carried out the statistical analysis with contributions from ES and KM. All authors contributed to data interpretation, reviewed successive drafts, and approved the final version of the report.

  • Funding: Natsal-1 was supported by a grant from the Wellcome Trust. Natsal -2 was supported by a grant from the Medical Research Council with funds from the Department of Health, the Scottish Executive, and the National Assembly for Wales. Natsal-3 was supported by grants from the Medical Research Council (G0701757) and the Wellcome Trust (084840) with contributions from the Economic and Social Research Council and Department of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The sponsors of the study played no role in the study design, data collection, data analysis, interpretation, or writing of the report. The corresponding author had full access to all the data in the study and final responsibility for submission.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work corresponding author must collect Unified Competing Interest forms from all authors and summarise their declarations as above within the manuscript.

  • Ethical approval: Natsal-3 was approved by the Oxfordshire Research Ethics Committee A (reference: 09/0604/27). The University College Hospital and North Thames multi-centre research ethics committees and local research ethics committees in Britain approved Natsal-2.

  • Transparency declaration: As lead author I (KW) affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Data sharing: Data from the National Surveys of Sexual Attitudes and Lifestyles (Natsal) are available from:

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