Contexts of sexualities in France

The fourth national survey on sexuality

The first scientific survey on sexual behaviors in France was conducted in 1970 by Pierre Simon and his team, involving 2,600 participants. This was followed in 1992 by the "Analysis of Sexual Behaviors in France" survey (ACSF-1992), led by Alfred Spira and Nathalie Bajos (Inserm), which included 20,000 individuals. In 2006, the survey titled "Context of Sexuality in France" (CSF-2006) oversseen by Nathalie Bajos (Inserm) and Michel Bozon (Ined), included 12,000 participants. The last two surveys, initiated and funded by the National Agency for Research on AIDS (ANRS), have resulted in numerous publications that have significantly informed the development of sexual health policies, particularly in relation to HIV infection.

The new survey "Context of Sexualities in France" (CSF-2023) required five years of work. Initiated in the fall of 2019, its timeline was delayed due to the Covid-19 pandemic.

This press release presents the methodology and the first results for continental France.

 

CSF-2023 research objectives

The multifaceted transformations of French society over the past few decades—encompassing social, legal, economic, and technological dimensions—have significantly influenced representations and practices related to sexuality and sexual health. Notable changes have taken place since the last survey in 2006.

Sexualities are shaped by a variety of institutions and social actors and are guided by social norms, which leads to their continuous evolution. In the CSF-2023 survey, as in previous editions, sexuality is explored through three key components: practices, relationships, and representations.

The World Health Organization (WHO) defines sexual health as "a state of physical, mental, and social well-being that requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free from coercion, discrimination, or violence" (WHO, 2006).

The CSF-2023 survey provides an opportunity to examine the diverse forms of sexuality and sexual health practices, aligning with the latest recommendations from the WHO working group on sexual health surveys.

Building on past surveys, the research addresses three dimensions:

1. The diversification of representations and practices within a social context characterized by evolving gender relations, changes in lifestyles, the development of digital spaces, issues related to consent, and shifts in the normative framework governing sexuality.
2. Additionally, the impact of living conditions on sexual life is examined, specifically how family dynamics, economic circumstances, professional environments, migration dynamics, and residential situations contribute to the emergence of new practices. These factors also influence individuals' ability to negotiate consensual and safe sexual relationships, as well as their access to sexual and reproductive health resources.
3. Furthermore, the research investigates the positive and/or negative relationships between different dimensions of sexuality and health (mental health, chronic illnesses, or functional limitations) at various stages of life. The research also explores new modalities for accessing the healthcare system, focusing on sexual education, choices and access to preventive tools, and treatment options through digital platforms.

Finally, the CSF-2023 research provides key indicators to evaluate the 2030 national sexual health strategy.

A robust methodology that has proven effective

The CSF-2023 research builds on the methodology used in previous telephone surveys while broadening the geographic coverage and age range studied. It introduces an online data collection component and incorporates a biomarker component utilizing urine and/or genital self-test kits.

This study encompasses continental France and four overseas territories: Martinique, Guadeloupe, Guyana, and Réunion. The target population now includes individuals aged 15 to 89, an expansion from the previous range of 18 to 69 years.

The methodology involves an initial telephone questionnaire (component 1), followed by an online self-questionnaire for adult respondents (component 2). Additionally, biological self-sampling is conducted for adults under 60 years of age (component PrévIST) to estimate the prevalence of sexually transmitted infections (STIs). The methodology has been validated through two pilot surveys aimed at testing the questionnaires and procedures.

Data collection among 31 518 respondents

The selection of participants was based on the generation of random phone numbers (80% mobile phones and 20% landlines), followed by the selection of one eligible participant aged 15 to 89 per number. In total, 21,259 individuals from continental France and 10,259 individuals from overseas territories participated in the research. Among these, 17,135 adults—12,906 from continental France and 4,229 from overseas territories—completed component 2 (the online questionnaire). Additionally, 5,735 respondents aged 18 to 59 took part in the PrévIST component, with 4,872 from continental France and 863 from overseas territories.

Data collection commenced in November 2022 and concluded in December 2023. The interviews were carried out by 133 interviewers from the Ipsos institute, who received training from the research team and field managers. Collectively, the interviews represented 65,000 hours of work for the interviewers. Their efforts were closely monitored on a daily basis by supervisors, field staff, and research team members to ensure the quality of the data collected.

Detailed questionnaires

The telephone questionnaire (component 1), which lasts an average of 34 minutes, explores the social and demographic characteristics of respondents and their current partners, health (perceived health, chronic illness, and functional limitations), attitudes towards sexuality, sexual education, isexual initiation, lifetime and 12 month number of partners and types of sexual practices. It also covers sexual orientation, digital sexuality, characteristics of the last sexual encounter, sexual violence, sexual dysfunctions, sexual satisfaction, and preventive practices (such as condom use, HPV vaccination, cancer screening, and contraception), unintended pregnancies, and sexually transmitted infections.

The supplementary self-administered online questionnaire (component 2), which lasts an average of 30 minutes, delves more deeply into certain topics (digital sexuality, last sexual encounter, pregnancy, mental health) while exploring additional subjects (seflcare for sexual health, discrimination, and medical follow-up).

Some of the questions are comparable to those in previous surveys, allowing for trendschanges over  analysis, while align with WHO's indicators on sexuality and sexual health surveys to facilitate international comparisons.

STI screening by auto-tests

Screening for the main bacterial sexually transmitted infections (Chlamydia trachomatis - Ct, Neisseria gonorrhoeae - Ng, and Mycoplasma genitalium - Mg) was offered to all individuals aged 18 to 59 who had previously engaged in sexual intercourse, with additional HPV screening for those aged 18 to 29. The goal was to estimate the prevalence of the most common infections while evaluating the impact of the national HPV vaccination strategy among younger individuals.

Participants who agreed to take part received a home self-collection kit—vaginal for women aged 18 to 59, and urinary for men aged 30 to 59; men aged 18 to 29 received both urinary and penile kits. These samples were mailed to the National Reference Center (CNR) for bacterial STIs, where analyses for the three bacterial STIs were conducted and results communicated back to the participants. Samples from individuals aged 18 to 29 were subsequently sent to the CNR for papillomavirus for HPV analysis.

Ethical considerations   

The research received ethical approval from the Sud Est 1 Ethics Committee (CPP Sud Est 1), the Inserm Ethical Evaluation Committee (CEEI-IRB), and the National Commission for Information Technology and Liberties (CNIL). Participants provided their oral consent to take part in each part of the research (telephone interview, online component, biological component) after being informed of the objectives and procedures. They were also provided with this information in writing via email, SMS, or by consulting the research website, where they could verify that their number had been selected for participation. Finally, PrévIST participants also confirmed their agreement in writing when returning their samples.

As in previous editions, special attention was given to the potential reactions that participation in the research might elicit, particularly concerning questions about sexual violence. Information on psychological and legal support services was provided to all participants, whether for themselves or for their entourage. For the interviewers, a psychologist held weekly support sessions for those who wished to discuss any difficulties they encountered. They were also offered Individual interviews as needed.  

Participation rates and  sample representiveness 

The CSF-2023 survey response rate is 34% in continental France, which is lower than in previous surveys. This decline in participation rates is observed across all general population surveys in France and abroad. A total of 21,259 individuals responded to the telephone questionnaire, of which 21,066 adults were eligible for the second component, and 12,906 completed the online questionnaire (61%). Finally, among the 15,280 sexually active individuals aged 18 to 59 eligible for the PrévIST component, 4,872 (32%) participated in the screening for bacterial STIs, while 811 of the 2,959 individuals aged 18 to 29 eligible for HPV screening participated (27% of those eligible).

The data from CSF-2023 have been weighted to account for inclusion probabilities and non-responses. This weighting, which relies on census data, ensures that the sample structure is representative of the population aged 15 to 89 living in France.

Table 1 : Distribution of CSF-2023 survey respondents living in continental France by age and sexe (%)

Ages	Women	Men
15-17 years	0.9%	0.9%
18-29 years	17.7%	18.5%
30-39 years	17.4%	18.0%
40-49 years	18.7%	19.2%
50-59 years	20.5%	20.5%
60-69 years	14.5%	14.0%
70-89 years	10.3%	8.9%
Ttotal	11019 (100%)	10235 (100%)

Reliability of Responses in Scientific Research on Sexuality and Comparison with Other Surveys

The reliability of responses is a critical issue in all scientific surveys, especially when studying sensitive topics. Numerous precautions were taken to ensure reliable responses, meaning answers that reflect the practices and opinions of the respondents, rather than those they believe are socially acceptable or valued.

First, all interviewers were trained by the research team on the scientific and ethical issues of the survey, ensuring the standardization of data collection while fostering a trusting relationship with the respondent to facilitate disclosures on sensitive subjects.

Second, express guarantees of confidentiality and anonymity of responses are fundamental conditions for participants to feel truly secure. Additionally, participants were asked to isolate themselves to complete the survey.

Additionally, some questions were asked both by phone and online to verify the consistency of responses.

Furthermore, analyses confirm the coherence of responses with previous surveys by comparing the results obtained for the same generation across two survey periods.

Comparing the results of CSF-2023, which relies on a random selection method, with non-scientific surveys is challenging. The samples from these surveys are not truly representative and are constructed using quota sampling, with differing data collection methods and question formulations.

 

First results

Continental France

1 Social landscape of sexualities

-> Age at first sexual intercourse : an increase in recent years

• In 2023, the median age at first sexual intercourse was 18.2 years for women and 17.7 years for men

The median age at first sexual intercourse, which is the age at which half of the population has had their first sexual experience, has decreased by nearly three years for women between the early 1960s and the mid-2000s (from 20.1 years to 17.3 years) and by one and a half years for men (from 18.8 years to 17.3 years). Since the late 2010s, this trend has slightly reversed, with an increase in the median age at first sexual intercourse for both genders. In 2019-2023, the median age reached 18.2 years for women and 17.7 years for men. The increase in the median age at first sexual intercourse is also observed in other countries, including the Danemark, Norway and Sweden (Hansen et al.; 2020) and the United States (Twenge et al.; 2017).

-> An increase in the number of sexual partners, with a significant gender gap remaining

• In 2023, women report an average of 7.9 lifetime partners and men an average of 16.4 lifetime partners

The average number of lifetime sexual partners among women aged 18-69 who have ever had sexual intercourse has increased over time, rising from an average of 3.4 partners in 1992 to 4.5 in 2006 and 7.9 in 2023. For men, these figures remained stable between 1992 and 2006 (11.2 and 11.9, respectively) then rose substantially to an average of 16.4 partners by 2023.

The prevalence of multiple partnerships in the past 12 months—defined as having several sexual partners during this period—has also grown, especially among young people aged 18 to 29. For women, the percentage rose from 9.6% in 1992 to 19.3% in 2006, and further to 23.9% in 2023. For men, this figure increased from 22.9% in 1992 to 29.0% in 2006, reaching 32.3% in 2023.

Table : Average number of lifetime sexual partners 

	Women			Men
Age	1992	2006	2023	1992	2006	2023
18-29 years	4.1	4,0	7.3	10.5	7.8	11.3
30-39 years	4.4	5.2	9.8	12.4	12.1	17.2
40-49 years	3.3	5.2	8.8	11.8	14.2	17.7
50-59 years	2.3	4.3	7.4	10.7	13.8	18.0
60-69 years	1.8	3.2	6.1	9.6	11.8	17.7
Total	3.4	4.5	7.9	11.2	11.9	16.4

Diversification of sexual practices

• In 2023, 73% of women and 93% of men aged 18-69 years reported ever engaging in masturbation

The repertoire of sexual practices has diversified over time, with more and more men and women reporting having experimented with sexual practices other than vaginal intercourse, such as masturbation, oral sex, and anal intercourse.

At all ages, individuals are increasingly likely to report having engaged in masturbation. The increase is much more pronounced among women. In 1992, 42.4% of women aged 18 to 69 reported having masturbated, rising to 56.5% in 2006 and 72.9% in 2023. For men of the same age, this practice has long been integrated into their sexual repertoire, and the increase is less significant, from 82.8% in 1992 to 89.9% in 2006, reaching 92.6% in 2023.

The percentage of individuals who have ever experienced fellatio (either performed or received) in their lifetime has significantly increased over time, rising from 63.2% in 1992 to 78.3% in 2006, and reaching 84.4% in 2023 among women. For men, the proportion has increased from 75.3% in 1992 to 85.5% in 2006, and then to 90.5% in 2023.

Similar trends are observed in the experience of cunnilingus (also either performed or received), with the percentage rising from 72.1% in 1992 to 83.7% in 2006 and 86.9% in 2023 among women, while for men, it rose from 77.8% to 85.7% and 87.7%, respectively.

The practice of anal penetration (performed or received) has also seen an increase over time among women, from 23.4% in 1992 to 35.2% in 2006, and 38.9% in 2023. The increase is even more pronounced among men, with figures rising from 29.6% to 46.3% and 57.4% over the same period. This practice appears to have been incorporated into the sexual repertoire at a later stage, especially among women, who are more likely to engage in it between the ages of 30 to 39 compared to those aged 18 to 29.

These developments indicate a broadening of sexual repertoires, a trend observed since the early 1970s, which reflects a more diverse sexuality increasingly less confined to vaginal penetration. Notable disparities in self-reported behaviors between women and men remain remain, particularly regarding masturbation and anal penetration.

 

Sexual and Gender Plurality

Social Acceptance of Homosexuality and Transidentity

• In 2023, 69.6% of women and 56.2% of men aged 18-89 believe that homosexuality is a form of sexuality like any other.
• In 2023,  41.9% of women and 31.6% of men ged 18-89 consider transidentity to be an identity like any other.

Social acceptance of homosexuality has made strides in recent years, but remains lower among men. In 2023, 69.6% of women over 18 and 56.2% of men in the same age bracket view homosexuality as a form of sexuality is any other. Notably, in 2006, there were more individuals who acknowledged homosexuality as a form of sexuality like any other than those who indicated they would accept their own child being homosexual. This trend has shifted by 2023; now, a higher proportion of people accept the possibility of their child being homosexual than those who affirm that homosexuality is a form of sexuality like any other. These shifts occur within a broader context of evolving rights for same-sex couples, highlighted by the passage of the law on marriage for all in 2013 and legislation providing access to assisted reproductive technology for female couples and single women in 2021.

In contrast, opinions on transidentity remain notably less favorable compared to those regarding homosexuality; only 41.9% of women and 31.6% of men view it as an identity like any other. Acceptance of a child's potential transidentity is also less prevalent, with 40.5% of women and 33.0% of men expressing that they would not have a problem accepting their child as transgender. This acceptance diminishes significantly with age. Furthermore, 10.7% of women and 10.8% of men perceive transidentity as a sign of open-mindedness

 Table 3 : Acceptability of homosexuality and transidentity in 2023 (%)

	Women	Men
homosexuality is a form of sexuality like any other	69.6%	56.2%
You would have no problem accepting your child’s potential homosexuality	77.9%	66.0%
Transidentity is an une identity like any cother	41.9%	31.6%
You would have no problem accepting your child’s potential transidentity	40.5%	33.0%

 

The Diversity of Sexual Orientations

• In 2023, 8.4% of women and 7.5% of men aged 18-89 report having had at least one same-sex partner in their lifetime

Sexual orientation consists of three dimensions that do not always overlap: attraction throughout life, sexual practices over time, and current sexual identity.

Today, attraction to a person of the same sex is reported more frequently than in previous surveys. In 2023, 13.4% of women and 7.6% of men aged 18-89 reported being attracted to individuals of the same sex during their lifetime. Additionally, 1.5% of women and 0.6% of men indicated attraction to individuals regardless of gender, including non-binary individuals. These findings are particularly prominent among young people aged 18-29, with 32.3% of women and 13.8% of men reporting same-sex attraction, and 4.3% of women and 1.7% of men indicating attraction to individuals irrespective of gender.

Sexual relationships with same-sex partners have increased over time, especially in the most recent period and among women. In 2023, 8.4% of women and 7.5% of men  aged 18-89 report having had at least one same-sex partner, with respectively 0.4% and 1.4% having only same-sex partners. These experiences are more common among young people aged 18 to 29 . For the first time in 2023, young women report more same-sex partners than young men: 14.8% had at least one same-sex partner (with 1.3% having exclusively same-sex partners), compared to 9.3% of young men (with 2.7% having exclusively same-sex partners).

In 2023, 1.3% of women and 2.3% of men aged 18-89 identify themselves as homosexual, while 2.8% of women and 2.3% of men identify as bisexual. Additionally, 1.5% of women and 0.6% of men consider themselves pansexual. Non-heterosexual identities are more prevalent among those aged 18-29, with 2.6% of women and 3.2% of men identifying as homosexual, 9.6% of women and 4.3% of men as bisexual, and 3.1% of women and 1.1% of men as pansexual.

When examining the overlaps among practices, attraction, and identity, more than one in five women (22.6%) and one in seven men (14.5%) do not strictly identify as heterosexual, as they report either an attraction, practice, or an identity that is not heterosexual. This is particularly true for women aged 18-29, with 37.6% identifying as non-strictly heterosexual, compared to 18.3% of men in the same age group.

The questioning of heterosexuality is increasingly common among younger generations, who have grown up—unlike their parents and grandparents—during a time of significant advancements in the rights and visibility of LGBTQA+ individuals. This challenge to heterosexual norms is especially notable among women, as they may benefit more from exploring alternative sexual orientations in light of the persistent inequalities and violence within heterosexual relationships—issues that are increasingly documented through the growing dissemination of feminist ideas.

Trans people or people who have thought about changing their gender 

• En 2023, 1 in one thousand  people has taken steps to change their gender and 2.3% of women and 2.4% of men have throught about changing their gender

One in a thousand individual (0,1% of the population) reports having taking steps to change genders.

Furthermore, 2.3% of women and 2.4% of men aged 18-89 report they have thought about changing their gender, which may include experiences of non-binarity and/or questions about their femininity or masculinity. Individuals aged 18 to 29 are the most likely to fall into this category (6% of both women and men in this age group). These statements do not indicate that a gender transition will be pursued, but they reflect an increasing awareness among younger generations regarding their gender identity.

Lastly, questioning one’s assigned sex at birth is partly associated with a challenge to heterosexuality. Among those who do not strictly identify as heterosexual, 6.9% of women and 11.0% of men have changed their gender or have thought about changing their gender, compared to just 1.0% of those who identify as strictly heterosexual.

 

Sexuality in digital spaces : a revolution in progress

• In 2023, 33% of women and 46,6% of men have ever had a sexual experience online with another person (connexion to a dedicated website, met a partner, exchanged intimate images)

Online sexual activities have significantly grown with technological advancements over the past two decades. According to the CSF-2006 survey, 10% of women and 13% of men reported having connected to a dating site. The widespread development of digital tools has created new avenues for sociability and new forms of sexual exchange, the extent of which remains poorly understood within the general population. The limited research on this topic often focuses on online dating, the impact of these new social spaces on younger individuals, and the associated social and health risks. In France, we still know very little about how these practices have permeated sexual exchanges and potentially transformed sexual behaviors.

The CSF-2023 survey provides the first opportunity to measure these practices in the general population. Specifically, 33.0% of women and 46.6% of men aged 18 to 89 surveyed in CSF-2023 reported having had an online sexual experience with another person, whether through connecting to a dating site, meeting a sexual partner online, or exchanging intimate images or videos. These practices are notably more prevalent among younger individuals and sexual minorities: 63.9% of women  and 72.8% of men under 30 report such experiences, along with 66.6% of women and 73.4% of men who identify as non-heterosexual.

In 2023, 17.9% of women and 23.7% of men indicate that they had met a sexual partner through a dating site or app. This includes 39.4% of women under 30 and 43.5% of men in the same age group.

Sexual activity itself can be digital when it involves remote sharing of intimate images (images or vidéos showing genital parts). A total of 13.8% of women and 17.9% of men aged 18 to 89 report they had sent an intimate image during their lifetime, this estimate rising to . However, this behavior is much more common among younger individuals: 36.6% of women and 39.6% of men in this age group have sent an intimate image, and 47.8% of women and 53.6% of men aged 18-29 have received such an image.

The survey provides insight into the context of these exchanges, particularly in terms of consent. When asked about consent during the last online sexual exchange, 56.4% of women and 69.3% of men indicated that they had explicitly consented to receive the image, while 15.9% of women and 25.0% of men reported that they had not considered the question in those terms. Finally, 28.8% of women and 6.4% of men stated that they had not consented.

Table 4 : Consent to receive the last intimate image by sender profile (%)

Last intimate image intime sender	Women	Men
Current partner/spouse	77.0%	71.4%
a known person	51.0%	73.6%
an unknown person	22.4%	57.2%
Total	54.8%	68.7%

The level of consent varies significantly based on the sender of the image. For example, while 77.0% of women consented to receive the last intimate image from their partner or spouse, only 51.0% gave their consent when it came from a friend or acquaintance, and just 22.4% were consenting if the sender was a stranger. In contrast, for men, the consent rate is similar whether the sender is a spouse or an acquaintance, and remains high (57.2%) even when the image is sent by an unknown individual.

The survey also measures the prevalence of harmful online experiences, by aggregating different forms of sexual harassment. This includes receiving unsolicited intimate messages or images of a sexual nature from one or more individuals, as well as the non-consensual diffusion of intimate images.

In 2023, 13.1% of women and 12.8% of men reported experiencing a harmful experience online. Among those under 30, this figure rises to one in three women and one in four men. While these harmful experiences are understandably more common among younger individuals due to their increased engagement in digital spaces, it is crucial to recognize that such experiences can occur at any age and impact nearly as many men as women after the age of 30.

The proliferation of digital practices over the past 20 years has gradually transformed the social landscape of sexual practices and relationships. This trend is observed across all countries that have conducted research on the subject (Mori et al., 2020). While these experiences are predominantly positive, they can also give rise to harmful situations and have detrimental effects, particularly on mental health. From a prevention standpoint, it is crucial to implement lifelong educational policies that address these new forms of intimate exchanges, alongside support systems for individuals experiencing digital sexual violence that may stem from these interactions

 

Increase in the reporting of sexual violence

• En 2023, 28,8% of women and 8,7% of men reported having experienced forced sex or attempted forced sex in their lifetime

Reports of sexual violence have increased over time, with a particularly significant rise observed between the 2006 and 2023 surveys. In 2006, 15.9% of women aged 18-69 reported having experienced forced sexual intercourse or attempted forced intercourse, while this figure climbed to 29.8% in 2023. For men, the percentage rose from 4.6% in 2006 to 8.7% in 2023. The increase is especially pronounced among young people aged 18-29, where the rate for women surged from 16.5% to 36.8% and for men from 4.7% to 12.4%. Notably, many of these incidents occurred while the individuals were minors at the time of the events.

These trends may indicate both a greater capacity to identify acts of violence and an increase in the frequency of such incidents, as well as a heightened willingness to discuss these experiences within the context of research. A comparison of indicators for the same cohort across the two surveys suggests a reporting effect. For instance, 19.5% of women aged 30 to 39 in 2006 reported experiencing sexual violence, a figure that rose to 26.8% among women aged 47 to 56 in 2023—17 years later. However, the reporting effect alone does not fully explain these observed changes; the definition of sexual violence itself has evolved over time. For example, marital rape has only gained legal recognition since 1992. Acts that were once deemed "normal" can now be rightly classified as sexual violence.

 

A recent decline in certain indicators of sexual activity.

• In 2023, 77% of women and 82% dof men report sexually activity with a partner in the last 12 months                        

Over time, sexual activity over the past 12 months, as well as the frequency of sexual intercourse in the last four weeks, has declined for both sexes across all age groups. In 1992, 86.4% of women aged 18 to 69 reported having had sexual intercourse in the past year; this figure fell to 82.9% in 2006 and further to 77.2% in 2023. Similarly, the percentage of sexually active men during the same period decreased from 92.1% in 1992 to 89.1% in 2006, and to 81.6% in 2023. However, the decline is much less pronounced among individuals living in couples. Despite these trends, the vast majority of the population continues to engage in sexual activity within the past year, including those in older age brackets.

Table 5 :  Has had sexual intercourse in last 12 months (%)

Sexe	Age	1992			2006			2023
		Couple	Single	Total	Couple	Single	Total	Couple	Single	Total
Women	18-29 years	99,4%	64,9%	83,7%	96,7%	58,2%	85,5%	96,0%	51,2%	79,4%
	Total (18-69 years)	96,7%	55,1%	86,4%	93,2%	40,8%	82,9%	90,9%	36,7%	77,2%
Men	18-29 years	99,5%	75,9%	85,9%	96,9%	69,6%	85,3%	95,4%	51,6%	74,1%
	Total (18-years ans)	98,0%	74,0%	92,1%	96,6%	61,0%	89,1%	93,7%	49,2%	81,6%

Women who have not had sexual intercourse in the past year predominantly report that this situation suits them, particularly among the younger and older age groups. Men, on the other hand, less frequently express satisfaction with this situation, particularly those aged 40-59.

The survey also reveals that, among individuals aged 18-69 who have had sexual intercourse in the past year, the frequency of sexual encounters in the last four weeks has declined significantly. For women, this figure fluctuated between 8.1 in 1992 and 8.6 in 2006, and declined to 6.0 in 2023. For men, it dropped from 9.0 in 1992 to 8.7 in 2006, and then to 6.7 in 2023. This downward trend is also evident among cohabiting couples.

Additionally, the proportion of individuals aged 18-69 who often or sometimes engage in sexual intercourse to please their partner, despite lacking genuine desire, has decreased for women since the mid-2000s. This percentage fell from 50.9% in 2006 to 43.7% in 2023, while remaining relatively stable for men, at 24.4% in 2006 and 23.4% in 2023.

Table 6 : Mean number of sexual acts in the last 4 weeks

	Women			Men
Âge	1992	2006	2023	1992	2006	2023
18-29	10.1	11,0	7,9	11,1	12,3	9,1
30-39	9.3	9,5	6,9	10,4	9,4	7,7
40-49	9.1	8,5	6,2	9,9	8,8	7.,1
50-59	5.3	7,0	5,0	6,9	6,9	5.8
60-69	4.4	5,2	3,3	5,4	5,7	4.3
Total	8.1	8.6	6.0	9.0	8.7	6.7

These results questions the very definition of sexual intercourse, which, while it may have evolved over time, still predominantly refers to a scenario involving vaginal or anal penetration. They must also be viewed in the context of the development of other forms of sexual experiences that the survey highlights.

These declining trends, both in terms of activity over the past twelve months and the frequency of sexual intercourse in the last four weeks, are also observed in other Western countries, including the United Kingdom (Wellings et al., 2019), Germany (Beutel et al., 2016), and the United States (Ueda et al., 2020).

 

A sexual life that extends after the age of 50

• In 2023, 56,6% of women and 73,8% of men remain sexually active after the age of 50. 

In 2023, 56.6% of women and 73.8% of men remain sexually active after the age of 50. Women typically experience a decline in sexual activity earlier than men. These differences can partly be attributed to relationship status at the time of the survey: among individuals in relationships, 77.2% of women and 84.9% of men reported having engaged in sexual activity in the past 12 months. The gender disparity is less pronounced when considering sexual satisfaction, which tends to decline with age and does so at a faster rate for men compared to women.

Slight increase in sexual satisfaction

• In 2023, 45% of women and 39% of men report being very satisfied with their current sexual life

The proportion of individuals reporting high satisfaction with their current sex life has remained relatively stable over time. For women, the percentages are 47.0% in 1992, 43.6% in 2006, and 45.3% in 2023. In contrast, men’s sexual satisfaction has declined, dropping from 45.0% in 1992 to 35.1% in 2006, before increasing to 39.0% in 2023. Today, sexual satisfaction is higher across all age groups compared to 2006 for both sexes, with the exceptions of women aged 30 to 39 and men over 60.

Figure 10 :  People reporting being very satisfied with their current sexual life (%)

	Women			Men
Âge	1992	2006	2023	1992	2006	2023
18-29	52,1	47,6	51,4	46,9	37,4	42,3
30-39	50,3	51,3	49,8	48,1	40,7	43,4
40-49	51,1	46,3	48,4	49,5	32,0	42,6
50-59	43,6	34,7	42,7	37,3	30,6	38,1
60-69	31,8	33,7	34,3	37,7	33,7	28,0
Total	47,0	43,6	45,3	45,0	35,1	39,0

 

2 Sexuality and Sexual Health

-> A Decline in prevention at the Onset of Sexual Activity

In 2023, 75.2% of women and 84.5% of men had used a condom during their first sexual intercourse.

The findings from the CSF-2023 survey reveal a substantial increase in contraceptive use during first sexual encounters between the early 1960s and the mid-2000s, rising from 31.8% among women and 23.1% among men in 1959-1963—prior to the legalization of contraception in 1967—to 98.3% for women and 97.1% for men in 2004-2006. However, after reaching this peak, the use of contraceptives during first sexual intercourse declined, falling to 87.2% for women and 92.3% for men who began having sexual intercourse between 2019 and 2023.

Similar patterns were observed in condom use at first sexual intercourse, although the rise was more pronounced during the 1980s and 1990s, coinciding with HIV prevention campaigns. The percentage of condom use during first sexual intercourse then decreased to 75.2% for women and 84.5% for men in the most recent period.

Consequently, the recent decline in the median age at first sexual intercourse does not align with an increase in protective measures during these initial experiences. This drop in prevention during first sexual encounters, which may contribute to the rise in reported STI rates since the early 2000s, raises critical questions regarding current prevention policies.

Limited Prevention in New Sexual Relationships

• En 2023, 49,4% of women and 52,6% of men reported using a condom during their first sexual intercourse with a partner met within the last 12 months.

In 2023, 49.4% of women and 52.6% of men indicated that they used a condom during their first encounter with a new partner met in the past 12 months. Condom use declines after the age of 60, with only 25% of men reporting condom use with a new partner and 0% of women (although only 19 women in the 69-89 age group have a new partner).

 

insufficient vaccination coverage

• In 2023,  63.5% of women and 52.9% of men aged 15-29 are vaccinated against hepatitis B, while 50.6% of women and 20.2% of men in the same age group have been vaccinated against papillomavirus (HPV)

Despite significant improvements among younger generations, vaccination coverage for sexually transmitted infections remains inadequate in 2023. Men, in particular, are less likely to be vaccinated and are less informed about their vaccination status compared to women. Hepatitis B vaccination coverage is 63.5% for women aged 15-29 and 52.9% for men in the same age group, exlcuding those who may have been vaccinated but are unaware of their status. Furthermore, vaccination coverage drops sharply after the age of 50, with fewer than half of the population vaccinated against hepatitis B.

Regarding HPV vaccination, coverage is also increasing among young people, reaching 61.3% among women aged 15-19 and 32.9% among men in the same age group. In addition, 16.8% of young men are unaware of their vaccination status and may have received the vaccine

Ces estimations sont en deçà des objectifs de la stratégie française de lutte contre le cancer lié au papillomavirus 2021-2030 qui préconise une couverture vaccinale contre le HPV de 80%. La couverture en France reste également en deçà du niveau atteint dans nombre des pays européens, en dépit de progrès récents, appelant à poursuivre les campagnes nationales d’information et la vaccination en milieu scolaire, qui s’avère la stratégie la plus efficace pour atteindre les adolescent·es.

These estimates fall short of the targets set by the 2021-2030 French strategy for combating HPV related cancers, which aims for an HPV vaccination coverage of 80%. Vaccination coverage in France also remains below the levels achieved in many European countries, despite recent progress, highlighting the need to continue national information campaigns and vaccination in schools, which has proven to be the most effective strategy for reaching adolescents.

Prévalence des IST en population générale

• In 2023, the prevalence of Chlamydia infection stands at 2.2% among women aged 18 to 29 and 1.9% among men in the same age group.

In 2023, the prevalence of Chlamydia trachomatis infections is 0.93% among women 18-59 yzars who have ever engaged in sexual intercourse and 0.58% among men. These rates are comparable to those from 2006 for women but reflect a slight decrease (which is not statistically significant) for men, dropping from 0.9% to 1.6% among those aged 18-44, for which the data are comparable. In light of the systematic screening policy offered to individuals under 26, a low prevalence is observed among younger people aged 18-25 (1.5% for women and 1.6% for men), while the prevalence rises significantly in the 26-29 age group, which is not included in screening efforts (7.9% for women and 4.4% for men). Moreover, individuals with multiple partners in the past 12 months are at a greater risk compared to those reporting only one partner (1.5% for women and 2.9% for men aged 18-59).

Only one case of Neisseria gonorrhoeae was detected, while the prevalence of Mycoplasma genitalium infections is estimated at 3.1% for women and 1.3% for men aged 18-59, with rates comparable to those seen in other European countries.

Table 7 : Prévalence of Chlamydia Trachomatis and Mycoplasma Genitalium infections in 2023 (‰ per thousand)

	Chlamydia Trachomatis		Mycoplasma Genitalium
Age	Women	Men	Women	Men
18-29 years	22.2 ‰	18.8 ‰	25.6 ‰	2.5 ‰
30-39 years	8.8 ‰	3.1 ‰	53.8 ‰	33.5 ‰
40-49 years	5.5 ‰	2.0 ‰	38.1 ‰	14.9 ‰
50-59 years	2.3 ‰	0 ‰	6.5 ‰	2.7 ‰
Total (18-59 years)	9.3 ‰	5.8 ‰	30.6 ‰	12.5 ‰

These results provide, for the first time, prevalence data on Mycoplasma genitalium infections in France. In the current context of rising Chlamydia Trachomatis and Neisseria Gonorrhoeae infections at both the European and French levels, they suggest that these increases are primarily affecting highly exposed populations rather than the overall population.

 

Risk associated with unintended pregnancies

A Changing Contraceptive Landscape

• In 2023, 91% of women aged 18 to 49 surveyed use a method of contraception, with the intrauterine device (IUD) becoming the most common method (27.7%), followed by the pill (26.8%) and condoms (18.6%).

Contraceptive coverage has remained stable between 2016 and 2023 among women aged 18-49 who are in need of contraception (i.e., those who have had heterosexual intercourse in the past year, are not pregnant, are not sterilized, and do not wish to become pregnant), although 9.0% report not using any method. The distribution of contraceptive methods has evolved significantly, revealing a growing disaffection with the pill since 2005. This trend intensified following the media crisis surrounding third- and fourth-generation pills in 2012 and continues into 2023. In 2005, more than half of women (55.8%) relied on the contraceptive pill, but this proportion fell to 36.4% in 2016 and to 26.8% in 2023. At the same time, women are increasingly using the intrauterine device (IUD), which has become the most widely used method in 2023 (27.7%), or condoms (18.6%). Other barrier and natural methods (withdrawal, cycle tracking, Ogino method, diaphragm) account for 7.5% of practices in 2023 while the use of implants remains marginal, with 4.4% of users opting for this method.

These changes are particularly pronounced among women aged 18 to 29 in need of contraception. Pill use has declined by 17.7 percentage points, dropping from 54.3% in 2016 to 36.6% in 2023, yet remains the most commonly used method. In contrast, the use of the intrauterine device (IUD) has risen by 8 percentage points, increasing from 10.9% in 2016 to 19.3% in 2023. Additionally, condom usage has grown by 4 percentage points, from 18.6% in 2016 to 22.3% in 2023. Although the proportion of women aged 18-29 using no method has risen from 4.3% in 2016 to 8.7% in 2023, they still represent a minority within this group.

Among women aged 30-49, pill use has decreased by 5 percentage points, falling from 26.9% in 2016 to 21.7% in 2023, whereas condom use has increased by 3 percentage points, rising from 13.2% in 2016 to 16.6% in 2023. Finally, among adolescents aged 15-17, the pill remains the primary contraceptive method employed in 2023, with 48.4% using it, followed by condoms at 30.0% and natural methods at 6.2%. Notably, 13.0% of this age group report not having any contraceptive coverage.

An Increase in Unintended Pregnancies

• In 2023, 34.7% of recent pregnancies that occurred within the last 5 years are reported as unintended.

In 2023, 12.8% of women aged 18 to 49 reported having experienced an unintended pregnancy in the past 5 years. This is nearly 4 percentage points higher than in 2016 (8.9%), although differences in the wording of survey questions may partly explain the discrepancies. Nevertheless, this increase is confirmed when using a consistent phrasing regarding the last pregnancy within the last 5 years, considered unintended (i.e., wanted later or not at all, or didn’t think about it) in 34.7% of cases in 2023, compared to 28.9% in 2016. Among young women aged 18 to 29, 51.8% of last pregnancies in the past 5 years are deemed unintended, compared to 27.8% among women aged 30 to 49.

These trends align with national abortion estimates based on data from the national health data system, which report an annual rate increasing from 13.9 abortions per 1,000 women in 2016 to 16.8 per 1,000 women in 2023.

 

Sexual and Gender Plurality and Health

• Individuals who have engaged in sexual activities with same-sex partners and those who have considered changing their gender are exposed to higher sexuality-related risks, particularly sexual violence, which affects their mental health.

Among individuals who have had same-sex partners, half (56.1% of women and 50.6% of men) report having used a condom during their first sexual encounter with a new partner met within the year. Additionally, these individuals exhibit a higher prevalence of STIs compared to the general population, reaching 1.4% for women and 2.4% for men aged 18-59.

Table 8: Sexual health indicators among individuals who have had same-sex partners (%).

	Women	Men
Condom at first sex with a new partner lin the last 12 months
18-29 years	51.9%	54.2%
30-89 years	60.9%	47.8%
18-89 years	56.1%	50.6%
Chlamydia Trachomatis infection (18-59 years)	1.4%	2.4%
Sexual violence (forced intercourse or attempts at forced intercourse) (18-89 ans)	53.1%	29.5%

Reports of sexual violence (forced intercourse or attempts at forced intercourse) are notably high among individuals who have had same-sex partners: 53.1% of women and 29.5% of men reported such experiences. These experiences partially explain the deterioration of their mental health compared to heterosexual individuals, with 35.9% of women aged 18-89 who reported same-sex partners exhibiting scores associated with moderate or severe depression, compared to 21.0% for women who reported only male partners. The trends are similar for men (23.4% versus 13.1%).

Individuals who have considered changing their gender have also experienced sexual violence at much higher rates than those who have never considered it (43.1% versus 17.2%). They report significantly higher rates of mental health issues associated with moderate or severe depression (43.7% versus 17.8%).

 

De-Medicalization of Sexual Health: Opportunities and Challenges of Digital Access

• In 2023, digital platforms represent a source of information for 75% of women and 69.7% of men, although a minority are in favor of accessing sexual health care online.

Empowering individuals to manage their sexual and reproductive health aligns with a movement toward promoting self-care practices, as advocated by the WHO to broaden access and ensure continuity of care while maintaining quality standards. Self-care practices refer to individuals' ability to seek information, prevent, and address illness and disability without the assistance of a healthcare provider. The expansion of digital platforms is contributing to the acceleration of this process of "de-medicalization," providing a wealth of information and access to self-testing, prevention, and treatment tools for STIs/HIV, unintended pregnancies, dysfunctions, or menopause symptoms.

The CSF-2023 research indicates that digital platforms are now an essential source of information, with 75.0% of women and 69.7% of men seeking SRH information online, highlighting notable generational differences in favor of younger individuals.

However, CSF-2023 also reveals that the social acceptance of online sexual and reproductive health services (such as abortion, contraception, and STI treatment) without a medical prescription remains modest. It ranges from 10.1% for medical abortions to 23.2% for pre-exposure prophylaxis (PrEP) for HIV. Nonetheless, acceptance increases among individuals facing stigmatizing practices or events, such as men who have sex with men or individuals who have experienced sexual violence, likely due to the confidentiality of online consultations.

These findings call for targeted actions to bridge the digital divide and improve the quality of online sexual and reproductive health services. It is also important to promote alternative solutions, such as over-the-counter access in pharmacies, as proposed in many countries for contraceptive pills, to meet the self-care needs in sexual health.

 

Overview

Overview

The latest research conducted by Inserm-ANRS on sexualities and sexual health in 2023 reveals trends that reflect developments observed over the past several decades. However, significant changes have emerged since the early 21st century, especially among women, within a context of increased social and economic autonomy, the advancement of gender and sexual equality, and the ongoing transformation of family structures. These changes also take place against a legislative backdrop that has evolved considerably in recent years. The 2013 law on same-sex marriages and the 2021 law on assisted reproductive technologies for female couples and single women have played a crucial role in reducing institutional discrimination against individuals with same-sex partners in their pursuit of marriage and parenthood.

The initial results illuminate what could be termed the “contemporary paradox of sexuality.” This paradox is characterized by greater diversity alongside a decreased intensity of sexual activity with a partner. The diversification of sexual activity is evident through the increase in the number of opposite-sex and same-sex partners, the extension of sexual activity into older ages, and the broadening of sexual repertoires, including masturbation. This trend is not new, but has intensified in recent years, particularly among women. At the same time, individuals report having engaged in sexual intercourse in the past twelve months less frequently than in 2006, especially those who are not in a relationship, and the frequency of sexual intercourse over the past four weeks has decreased regardless of relationship status. These trends are also observed in other countries, including Germany, the United States, Finland, the United Kingdom, and Japan.

The factors driving these trends are multifaceted. Firstly, women and men under 69 in France are less likely to be in a relationship today compared to previous decades (Rault and Réigner-Loilier 2015). As a result, periods without a stable partner have become more common in 2023 than in the past. The rise of digital spaces for sexual expression also contributes to this shift, particularly among younger individuals, as sexual experiences not only involve physical settings but also occur online. Additionally, research indicates that the COVID-19 pandemic, especially during lockdowns, has adversely affected the mental health of young people in the long term (Hazo and Costemalle 2021), potentially altering their expectations regarding sexuality.

Furthermore, these changes occur within a broader context that challenges traditional perceptions of women’s sexual availability. The results indicate a decline since 2006 in the frequency of sexual encounters women accept to please their partner, even when they themselves are not interested. Today, younger generations seem to view a lack of sexual activity as less problematic than in the past. Similarly, the belief that men have "naturally" greater sexual needs than women, which prevailed in 2006, no longer holds true in 2023. Notably, these shifts do not appear to diminish the sexual satisfaction of either women or men, as both groups continue to report similar levels of satisfaction with their sex lives as they did in 2006.

The CSF-2023 survey also highlights an increasing challenge to the heterosexual norm in attitudes and practices. Social acceptance of non-heterosexual sexualities has grown significantly over time, although notable resistance still exists, and discrimination against individuals with same-sex partners, particularly against transgender people, remains frequent, negatively impacting their mental health. Among individuals who have had same-sex partners, only half (56.1% of women and 50.6% of men) report having used a condom during their first sexual encounter with a new partner. Furthermore, these individuals exhibit a higher prevalence of STIs compared to the general population, reaching 1.4% for women and 2.4% for men aged 18-59.

The CSF-2023 findings suggest that it is ultimately the contours of sexuality that are evolving, as heterosexual penetrative sexuality gradually gives way to a more diverse practices, less focused on vaginal penetration and increasingly occurring in digital spaces, and is notably less frequent but more often desired.

This shift can be viewed in relation to the ongoing increase in reports of sexual violence, a trend that began well before the #MeToo movement. The growing social mobilization against all forms of sexual violence has transformed the normative frameworks of sexual consent. The rise in reported incidents reflects both an acknowledgment by respondents of events that were previously not considered violent and a greater capacity to denounce such occurrences. However, the results of this new survey paint a concerning picture of the extent of these violences, and statistics regarding younger generations illustrate the continued prevalence of the issue.

The survey also shows that transidentity and questioning gender binary norms remain stigmatized, significantly more so than homosexuality, and individuals who have considered changing their gender report considerably poorer mental health outcomes than others. Nevertheless, social acceptance of transgender and non-binary individuals is evolving, as evidenced by more favorable attitudes from younger generations. It is also among the youngest age groups that a greater number of individuals have thought about changing their gender at some point in their lives. These results indicate a growing reflexivity among individuals regarding their own gender, which is no longer simply experienced as a biological given.

Even though gender inequalities remain pronounced from the onset of sexual activity through to older ages, and discrimination against individuals with same-sex partners and transgender individuals remains common, the developments highlighted by the 2023 survey overall reflect a growing trend toward gender and sexual equality in French society. The results also shed light on the issues related to the prevention of risks associated with sexuality. The use of condoms during first sexual encounters has declined in recent years, and the protection observed during initial sexual encounters with new partners falls significantly short of the recommendations set forth by the national sexual health strategy. Additionally, vaccination coverage for hepatitis B and the papillomavirus (HPV) remains low, particularly among men. While contraceptive coverage is generally very high, the types of methods used have evolved considerably. The results confirm a decreasing reliance on the pill, a trend observed since 2005 that intensified following the media crisis of 2012, particularly among young people, who are increasingly turning to the intrauterine device (IUD) and condoms, although the pill remains the most commonly used method in this age group. Among women aged 18-49, the IUD has become the most widely used method in 2023. Meanwhile, non-medical methods are on the rise, with one in ten women remaining without contraceptive protection. The survey also notes an increase in unintended pregnancies among young women, reflecting the rise in the incidence of voluntary terminations of pregnancy observed since 2016. These findings call for a reconsideration of prevention programs for STIs and unintended pregnancies, while integrating digital tools that can help expand access to care, provided they adhere to the same quality standards as other health care sources. The digitalization of sexual health represents a broader challenge of de-medicalizing sexual health in France, which is still in its early stages compared to policies implemented in other countries, such as England and the United States.

* * *

Numerous analyses are currently underway, which will provide a deeper understanding of the results presented here, taking into account the detailed social characteristics of individuals. The ongoing analyses also focus on emotional and sexual trajectories, the use of pornography, paid sexual exchanges, norms and representations of sexuality, feminism and sexuality, sexuality in older age, consent, the links between sexuality and diseases, prevention practices, and medical violence, among other topics. These analyses will cover both metropolitan France and the overseas territories (Martinique, Guadeloupe, Guyana, Réunion). They will also allow for international comparisons with countries that have conducted similar types of surveys based on WHO protocols, such as Canada and England.

Results will be published in 2025 in a special issue of the journal Perspectives on Sexual and Reproductive Health, and in-depth analyses will be presented in a forthcoming book to be published in 2026 by La Découverte.

 

The Research team

The Inserm research project "Contexts of Sexualities in France" was initiated by ANRS-Emerging Infectious Diseases, under the scientific responsibility of Nathalie Bajos, a sociologist at Inserm, Caroline Moreau, an epidemiologist at Inserm, and Armelle Andro, a demographer at Paris 1 Panthéon-Sorbonne University, and coordinated by Aline Bohet, a public health project manager at Inserm. The biomarker component of the research (PrévIST) was conducted under the leadership of Florence Lot, an epidemiologist at Public Health France, in collaboration with the National Reference Center (CNR) for bacterial sexually transmitted infections and the CNR for papillomavirus infections.

The research team includes researchers in sociology, demography, epidemiology, and economics from Inserm, Ined, CNRS, Public Health France, Paris 1 Panthéon-Sorbonne University, and the University of Strasbourg.

Financial support

The research is financially supported by ANRS-Emerging Infectious Diseases, Inserm, and Paris 1 Panthéon-Sorbonne University, with the collaboration of Public Health France (SpFrance), the National Institute of Youth and Popular Education (INJEP), the Interministerial Mission for the Fight Against Drugs and Addictive Behaviors (MILDECA), and the General Directorate of Health (DGS).

Acknowlegments

We would like to thank the 31,518 survey participants whose responses form the basis of this work, as well as the interviewers and study coordinators from the polling institute IPSOS. We also extend our gratitude to Louis Kuhn and Antoine Sireyjol, who contributed to the statistical analyses. Additionally, we thank the members of the CSF2023‘s scientific advisory board, chaired by François Héran, anthropologist and professor at the Collège de France, as well as the members of the steering committee, chaired by Alfred Spira, epidemiologist, who supported our work throughout the research process.

 

 

---

---