Oral, Vaginal and Anal Sexual Practices among Heterosexual Males and Females Attending a Sexual Health Clinic: A Cross-Sectional Survey in Melbourne, Australia

Abstract

Sex practices among heterosexuals are not well studied. We aimed to explore sexual practices among heterosexuals attending a sexual health clinic. This cross-sectional survey was conducted at Melbourne Sexual Health Centre between March and April 2019. Data were collected on kissing, oral sex (fellatio or cunnilingus), vaginal sex, anal sex and rimming in the previous 3 months. Univariable and multivariable logistic regression analyses were performed to examine the associations between engaging in anal sex and other sex practices. There were 709 participants (333 men; 376 women) who were eligible and completed the survey (response rate was 24.6%). In the past 3 months, most participants had had vaginal sex (n = 677; 95.5%), with a mean of 3.0 (standard deviation (SD): 3.9) vaginal sex partners, and half reported engaging in condomless vaginal sex in the past 3 months (n = 358; 50.1%). A total of 135 (19.0%) participants had had anal sex, with a mean of 1.3 (SD: 1.0) anal sex partners, with 63.5% (n = 94) engaging in any condomless anal sex in the past 3 months. Most participants (n = 637, 89.8%) had received oral sex in the past 3 months; this proportion did not differ by age group or gender. Women (n = 351, 93.4%) were more likely to perform oral sex than men (n = 275; 82.6% men) (p < 0.001) and to have received rimming (26.6% women vs. 12.6% men; p < 0.001). Men were more likely to have performed rimming (25.5% men vs. 9.3% women; p < 0.001). After adjusting for age, number of partners and sexual practice, anal sex was associated with being ≥35 years (adjusted odds ratio (aOR): 2.3; 95% CI: 1.2–4.2), receiving rimming (aOR: 3.8; 95% CI: 2.4–6.0) and performing rimming (aOR: 2.8; 95% CI: 1.8–4.6). Rimming and anal sex are practiced by one-fifth or more of heterosexuals. Older heterosexuals were more likely to engage in anal sex and to perform rimming. Future research should consider the benefits of testing extragenital sites where appropriate.

Sexual activities and condom use among heterosexual men and women engaged in mixed-gender group sex events in Melbourne, Australia

“…Studies suggest that 34-50% of heterosexual men and women in Melbourne reported consistent condom use with casual partners in the past 12 months. [10][11][12][13] Our study found that 41% of men and 34% of women used condoms with every partner during their most recent group sex event.…”

“…11,14,16 As the proportion of heterosexuals who always used condoms and changed them between partners during group sex was relatively low (36% in men and 28% in women), safe sex practices should be reinforced among individuals especially in group sex to minimise STI acquisition risk. Past studies have shown oral and anal sex are common in heterosexuals, 13 but there has been no data on changing condoms between oral, vaginal and anal sex during mixed-gender group sex events; therefore, further studies are required to explore patterns of condom use in the heterosexual population.…”

“…This finding is similar to that of Phillips and colleagues' findings in 2021, who surveyed 709 heterosexual men and women in Melbourne and found that heterosexual women were significantly more likely to report samesex tongue-kissing compared to men beyond group sex events. 13,21 This may reflect the stigmatisation or cultural taboo of same-sex kissing among heterosexual men due to the increased sexual connotations associated with kissing. 13,22 A study by Bettinsoli and colleagues in 2019 across 23 countries worldwide (including Australia) found that stronger negative attitudes towards non-heterosexual individuals are held by men compared to women in each country studied.…”

“…13,21 This may reflect the stigmatisation or cultural taboo of same-sex kissing among heterosexual men due to the increased sexual connotations associated with kissing. 13,22 A study by Bettinsoli and colleagues in 2019 across 23 countries worldwide (including Australia) found that stronger negative attitudes towards non-heterosexual individuals are held by men compared to women in each country studied. 23 However, given the growing acceptance of samesex activity in Australia and in other settings, past studies have shown that heterosexual men are now more open to same-sex sexual or semi-sexual contact.…”

Factors associated with group sex in heterosexual males and females attending a sexual health clinic in Melbourne, Australia: a cross-sectional survey

“…Depending on the self-reported sexual activities they disclosed on CASI, clients were shown one of the ASAP surveys. In this study, we analysed data from the heterosexual population (defined as having only oppositesex partners in the previous 12 months, as described previously 14 ) because data on group sex in MSM and FSW had been reported and published elsewhere. 4,15 Men were shown survey (b) for 'heterosexual men' if they reported having sex with an opposite-sex partner and did not have any same-sex partners in the previous 12 months.…”