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A recent study evaluating sexual well-being in the United States suggests that while many people report positive and wanted sexual experiences, significant gaps remain in testing, communication, and overall satisfaction. Published in the Journal of Sex & Marital Therapy, the findings provide evidence of persistent gender disparities and a widespread lack of access to preventive care. These insights highlight the need for more comprehensive approaches to reproductive and sexual well-being across the country.
Public health initiatives in the United States have historically approached sexual health through narrow categories. Government and state programs tend to focus on preventing specific diseases or managing family planning. This fragmented 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, such as restricted access to abortion and reproductive care, have created new challenges for public health.
“I’ve spent much of my career thinking about how to measure sexual health in meaningful ways,” Jessie Ford, an assistant professor in the Department of Sociomedical Sciences at Columbia University, told PsyPost. “Since around 2010, my work has focused on developing and refining approaches that go beyond disease to capture aspects like pleasure, satisfaction, and communication.”
To gather more comprehensive data, researchers used the World Health Organization’s Sexual Health Assessment of Practices and Experiences survey. This standardized questionnaire assesses knowledge, behaviors, and health outcomes across different global populations. The scientists selected specific indicators from this tool and supplemented them with two additional questions from federal surveys about communication comfort.
“More recently, I’ve been at 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 in July 2024 through a market research company. They recruited a sample of 2,555 English-speaking adults living in the United States, ranging in age from 18 to 94 years old.
“So when the opportunity came up to implement the SHAPE survey in the U.S. with colleagues, I was eager to be involved,” Ford said. “It felt like a unique chance to better understand what sexual health looks like in practice—and what the findings might reveal about both progress and ongoing gaps.”
To ensure data quality, the recruitment platform used fraud detection tools to filter out automated responses and duplicate accounts. The final group included more women than men, with 56 percent identifying as female and 43 percent as male. About 71 percent of the participants identified as heterosexual.
When looking at the survey responses, researchers found that sexual encounters were generally consensual and physically rewarding. Approximately 89 percent of participants described their most recent sexual experience as wanted. About 87 percent reported that their last sexual encounter was pleasurable.
Despite these positive reports, overall contentment was moderate. Only 56 percent of the sample reported feeling satisfied with their sex life over the past year.
“I was struck by a kind of disconnect in the overall data,” Ford noted. “At the most recent sexual encounter, people reported very high levels of wantedness (89%) and pleasure (87%). But when asked about their sexual satisfaction more broadly over the past year, that drops to 56%.”
This discrepancy suggests that individual encounters do not always translate to long-term fulfillment. “That gap raises a lot of interesting questions,” Ford added. “It suggests that while individual sexual experiences may often be positive, people may not be having the kinds of sexual lives they want overall. Are people not having sex as often as they’d like? Are there unmet desires or constraints within relationships? Are people having pleasurable encounters but lacking consistency, connection, or fulfillment over time?”
The survey also provided evidence of significant gaps in preventive healthcare and routine testing. Exactly 50 percent of the participants had never been tested for the human immunodeficiency virus, commonly known as HIV. Additionally, 47 percent had never been tested for any other sexually transmitted infections.
The data revealed differences based on gender identity. Women and individuals of 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 for gender-diverse individuals were even more pronounced than I expected,” Ford said. “This group showed many indicators we typically associate with strong sexual health—greater comfort communicating with partners, more progressive attitudes, and higher levels of sexual health knowledge. And yet, they reported worse outcomes across several domains, including lower sexual satisfaction, lower rates of STI and HIV testing, reduced feelings of safety, and higher exposure to sexual violence.”
This contrast suggests that progressive attitudes and open communication are not enough to protect marginalized groups. “That contrast highlights that knowledge and openness alone are not protective—there are deeper structural vulnerabilities that need more tailored, affirming responses,” Ford explained.
Communication about sexual health showed a divide depending on the conversation partner. Nearly half of the respondents felt completely comfortable discussing sexual health with their partners, but only 31 percent felt comfortable having these same conversations with their healthcare providers.
“One of the main takeaways is that sexual health in the U.S. is marked by both real progress and persistent gaps—it can often feel like one step forward, two steps back,” Ford said. “On the positive side, many people report that sex is wanted and pleasurable, and there are signs of cultural shifts, like greater comfort talking with partners about sexual health and increased acceptance of same-sex relationships. These are meaningful indicators of progress.”
However, significant challenges remain. “At the same time, the gaps are striking,” she continued. “Women and gender-diverse individuals continue to report lower pleasure, higher exposure to sexual violence, and less safety. We also see relatively low levels of communication with healthcare providers, and many people have never been tested for HIV or other STIs. High rates of unintended and adolescent pregnancy further point to ongoing structural and educational challenges.”
The researchers noted some limitations that should be considered when interpreting these numbers. The study relied on self-reported data gathered from an online opt-in panel, meaning participants actively chose to join the survey platform.
“This was a cross-sectional, online survey, so we can’t make causal claims about why these patterns exist,” Ford explained. “The data provide a snapshot in time rather than showing how sexual health changes over time.”
The demographic makeup of the sample was not entirely representative of the broader population. “While the sample included a wide age range and diverse participants, it is not fully 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 comfort discussing these topics.”
The team also did not use statistical methods to rule out other variables that might explain gender differences. For example, they did not use regression analyses, which are statistical techniques that help scientists determine how strongly different factors influence a specific outcome.
“As a result, the gender differences we report should be interpreted as descriptive patterns rather than causal or fully explained disparities,” Ford noted.
She also cautioned that measures like “wanted” sex can be interpreted differently by different people. “Another point is that measures like ‘wanted’ sex and pleasure can be interpreted in different ways by participants,” Ford said. “I’d argue that coexistence of high wantedness alongside reports of negative or non-consensual experiences shouldn’t be seen so much as contradictory, but 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 inequities revealed by the survey.
“Longer term, I’d love to see sexual health treated as a core public health priority in the United States,” Ford told PsyPost. “One goal is to work with agencies like the Centers for Disease Control and Prevention and other national surveillance systems to develop an annual sexual health ‘scorecard’—something that tracks progress in a way that is transparent, engaging, and motivates us to do better as a country.”
“More broadly, this work connects to the need for a coordinated U.S. national sexual health strategy—one 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 more holistic approaches to sexual health is essential for improving outcomes, especially for marginalized communities.”
The study, “The State of Sexual Health in United States of America in 2024: Results from the World Health Organization’s Sexual Health Survey (SHAPE),” was authored by Jessie V. Ford, Eli Coleman, Leonor de Oliveira, Ryan L. Rahm-Knigge, and Kristen P. Mark.
