Background
Young people are at the beginning of their sexual and reproductive lives. How they are prepared for this journey has tremendous implications for their future lives and the health of the next generation. Sexual behaviors refer to a variety of sexual acts, such as talking about sex, solitary masturbation, intimacy, and sexual intercourse through their experiences and expressing their sexuality. Youth sexual behavior is highly relevant to different public health problems [
1,
2]. For example, youth unprotected sexual intercourse contributes to unwanted pregnancies, abortions, pregnancy related complications, and sexually transmitted infections (STIs) including HIV/AIDS [
3]. While there are numerous studies on sexual behaviors and health among young people in Western countries, such investigations have been rare in different Chinese communities. Understanding the prevalence and psychosocial correlates of sexual behaviors in young Chinese people would provide important information on the development and implementation of effective sex education programs in China and thus help Chinese youth develop healthy and safe sexual behaviors. As such, the present study aims to investigate the prevalence and psychosocial correlates of sexual behaviors in young Chinese people based on a large sample of University students in Hefei, a typical middle-sized city in China.
In recent decades, a large number of studies have examined the prevalence of youth sexual behaviors usually in multiple aspects of heterosexual and homosexual intercourse, sexual coercion, masturbation, and pornography viewing in Western countries [
4]. For example, a study found 80% of the males and 73% of the females had experienced heterosexual intercourse in United States [
5]. Overall, 74% of university students reported ever having had sexual intercourse in Turkey [
6]. A report conducted among 8658 American university students found 5% students had sexual experiences with members of their own sex [
7]. Worldwide evidence shows that the experience of sexual coercion is fairly prevalent among young people. Approximately 25–33% of college women in the United States reported experiencing forced touching of sexual parts and around 10% of college women reported experiencing forced oral, anal, and/or vaginal intercourse [
8]. It was found that 92% of men and 77% of women university students had masturbated in the United States [
9]. In Denmark 97.8% of males and 79.5% of females watched pornography among 1002 people aged from 18–30 years old [
10].
In China, a limited number of studies have attempted to examine the occurrence of sexual behaviors in university students in the past two decades. In 1989, a general survey on university students’ lives was conducted in Beijing, which revealed that around 13% of male students and 6% of female students had encountered sexual experiences [
11]. In 1992, a similar study in Shanghai indicated that 18.8% of male university students and 16.8% of female students had engaged in premarital sex [
12]. In 2000, a nationwide survey involving over 5000 participants from 26 universities in 14 provinces revealed that 11.3% of university students experienced sexual intercourse [
13]. Meanwhile, a multi-year longitudinal study in Beijing revealed that the percentage of premarital sex among university students rose from 16.9% in 2001 to 32% in 2006 [
14]. While these results provided useful information about the general situation of sexual behaviors in Chinese university students, most studies only adopted single-item “Yes” or “No” questions to obtain information regarding whether the student had sexual intercourse or not. Multiple aspects of sexual behaviors, such as same-sex sexual contact and sexual communication, are unknown. Obviously, such studies cannot provide a clear picture about Chinese university students’ sexual behaviors in different aspects. Therefore, there is a critical need to further investigate this phenomenon by using comprehensive assessment tools which can assess multiple dimensions of youth sexual behaviors in China.
Several important predictors of youth sexual behaviors have been reported by Western researchers. A study revealed students with lower grades, compared to those with higher grades, were more likely to have sexual intercourse experience in high school [
15]. College students from the cities and towns were more prone to sexual intercourse than those from a rural area [
16]. In high school, teenagers with bad school achievements were more likely to have already lost their virginity and engage in more sexual activities than those who achieved academic success [
17]. In terms of sex education, it has been a controversial subject in some countries for a long time, such as the USA and China. A large number of studies conducted across the world examined it and its association with youth’s sexual behaviors. Some found sex education may reduce the level of sexual activities and risk sexual behaviors [
18]. Some findings found that sex education might not cause any sexual behavior changes [
19]. Studies commonly demonstrated that among adolescents and young people, being in a romantic relationship is significantly associated with an increased likelihood of sexual initiation and sexual activities [
20]. Also, exposure to the Internet and the messages they present are greatly influential factors on American adolescents [
21]. Although studies have yielded valuable information to understand psychosocial correlates of sexual behaviors among adolescent and young people, most of such studies were conducted with western contexts. There is no research examining whether and how these factors also affect Chinese university students’ sexual behaviors. The present study was the first study to attempt to explore psychosocial correlates of sexual behaviors based on Chinese context.
Furthermore, factors that affect sexual behaviors appear to be different for males and females. Many studies in western countries indicate that males are more likely to initiate sexual intercourse, higher prevalence rate, more frequent sexual behaviors and significantly higher risk behavior than girls [
22,
23]. Males were more likely to report having lost their virginity and having initiated sexual intercourse in earlier age and more sexual partners than females [
24]. Young people often learn from experience, and their experiences may influence their subsequent behavior. This process may vary for male and female youth, since society often places different meanings on sexual activity for males and females. For example, stronger social and emotional sanctions have been associated with sexual activity for females than for males [
25]. Males tend to receive more permissiveness from society for premarital sexual activity than females. Given that sexual behaviors have different implications for males and females, psychosocial factors associated with sexual behaviors will vary as well. However, it is unclear how gender differences on prevalence of sexual behaviors are; what and how psychosocial factors linked to sexual behaviors for Chinese male and female students. Thus, it is necessary to explore how gender differences on prevalence of sexual behaviors; what and how psychosocial factors were associated with sexual behaviors for males and females, respectively.
Against the research background, the present study was designed to address three primary research questions: (a) how prevalent are sexual behaviors among university students in Hefei. (b) What are the gender differences in prevalence of sexual behaviors? (c) What are the factors associated with sexual behaviors for males and females, respectively?
Discussion
The present study found that rates of heterosexual intercourse reported by the university students in Hefei who responded to our study were 12.6% (15.4% males and 8.5% females). These rates fall within the ranges reported by Chinese university students in other Chinese cities since 1995 [
16,
28,
29]. During the last decade, the rates of heterosexual intercourse among Chinese university students do not appear to have undergone a dramatic change, remaining the similar with or no big different from rates observed in neighboring regions or countries. For example, it was reported that 22% of never married youth aged 20 years having had sex in Taiwan in 2004 [
30]. And in the Survey Assessment of Vietnamese Youth conducted in late 2003, it was found that 16.7% male and 2.4% female aged 18 to 25 years engaged sexual intercourse [
31]. It may be because the regions in Asia, such as Taiwan, Korea, Vietnam and Japan, share the same Confucian-based traditional culture expecting in terms of sexuality that men and women should conduct themselves properly from an emotional distance at all times and not have any contact before marriage [
32]. Although they have been open to outside influences socially, culturally and economically for different periods and in different ways, their sharing traditional culture still rooted in societies deeply. Compared to western countries, the percentage in China remained much lower than rates observed in the USA that 80% of male university students and 73% of female university students had heterosexual intercourse and in Scotland that around 74% university students had heterosexual intercourse during the 1990s and early 2000s [
33,
34]. This may be related to vast differences in cultural and social context. A specific example is that the Chinese Ministry of Education prohibited marriage among university students until 2005 and the universities offer a context which discouraged university students’ sexual activities. In China, many universities have direct and indirect regulations that limit intimate relationships between students of opposite sex in school. For example, every student must live in school and males were not allowed to enter female dormitories; students must come back to the dormitory before 10:30 pm since the gates of dormitories usually close at 10:30 pm, with the lights turned off at 11:30 pm. In addition to heterosexual intercourse, our results also clearly indicate that there were other acts among university students, with both male and female students having oral sex, the same-sex activities, and forcing and being forced to have sex. The results may indicate that sex education not only advocates abstinence as a good way for safe sex, but also provides comprehensive sex education including sexual knowledge about reproductive health, condom and contraception use, proper and responsible sexual attitude for protective, and safe sex behaviors among young people.
There are six items in the sexual behaviors questionnaire asking students about their communication with other people on sexual topics or other ways of acquiring sexual knowledge (e.g., viewing pornography videos or magazines). With respect to communication on sexual topics, the results of the current study suggest that parent-adolescent communication on sex was quite infrequent in China than in Western countries. A study conducted in Sweden reported that 40% of male and 60% of female high school students had talked with their parents about sex [
35]. However, in the current study, only 13.7% (10.7% males and 18% females) students talked with parents about sex, and only 7.1% (6.1% males and 8.4% female) students talked with parents about contraception in the last one year in China. Given the important role parents play in adolescents’ life [
35], parental involvement in adolescent sex education needs to be enhanced. For example, parents should be encouraged to communicate with and educate children about sex in an environment of openness when they are most drawn to sexual behaviors during their adolescence. The study also revealed the large proportion of students, especially male students, who saw pornography such as books/magazines/videos/websites. It may suggest that pornography may be a ready source of basic information about sex for Chinese youth and may have had some influence on respondents’ sexual practices. It becomes quite necessary to incorporate pornography topics in sex education for university students in China [
15]. For example, educating youth about the realism of pornography and the relationship between media and life; encouraging students to reflectively think and discuss what the possible benefits and harmful effects of pornography are for young people, why people use it, and what the law says about it.
This study found significant gender differences (male > female) in prevalence of heterosexual intercourse, masturbation, sex fantasies, exposure to pornographic media; these differences were consistent with previous studies done in China and USA [
29,
36,
37]. The difference of heterosexual intercourse may be explained by noting that whereas premarital heterosexual intercourse for boys is considered a socially acceptable rite of passage, girls tend to be labeled and stigmatized and are often blamed for sexual encounters that could result in pregnancy and sexually transmitted infections [
38]. Attitudes and beliefs from family and society still expected men to take responsibility for initiating and ending sexual activity. Women are expected to be virgins before marriage and less sexually initiating than men [
14,
39]. Gender differences in sex fantasy, masturbation and pornography use may also be partially due to sex drive. Research suggests that men on average have a stronger sex drive and are more aroused by pornography than women do [
40]. Alternatively, the large gender differences in sex fantasy, masturbation and pornography use may be explained by socially desirable responding. Stigma continues to be associated with female autoerotic behaviors particularly in different Chinese communities; therefore, women may underreport rates of masturbation or pornography use [
38].
Consistent with previous studies, it was found that the incidence of sexual behaviors in the past year for university students were positively related to having romantic relationship experience, received sex education, lower education aspiration, longer time spent online and living urban area for male and having romantic relationship experience and living in urban area for female.
Among all the factors identified predicting university students’ sexual behaviors, having romantic relationship experience had the strongest explanative power for both male and female. Several studies have evidenced that dating, especially steady romantic relationship is a prominent factor associated with sexual behaviors. Having a boyfriend or girlfriend may increase the opportunity for engaging in intimate and precoital behaviors, such as kissing and fondling, which may be followed by sex. Furthermore, having a boyfriend or girlfriend may expose a youth to a new set of friends, who may share more permissive norms about sex; many studies have demonstrated that youth whose peer norms encourage sexual activity have an increased likelihood of being sexually active. Thus, young people in romantic relationships have extra need for information about intimacy and sexual risk and safety. The study suggests the importance of targeting education efforts toward young people in romantic relationship [
41]. Schools and parents should help young people, in particular those in romantic relationship, to develop skills and abilities in relationship and intimacy including teaching sexual health knowledge, advocating safe sexual behaviors, and to make rational sexual decision.
Received sex education has the second most influential source to explain male students’ sexual behaviors. For males, students with received sex education showed significantly more sexual behaviors than those without such experiences. This seems to be inconsistent with the “good intention” of Chinese mainstream society that sex education should delay sexual initiation and decrease sexual activities among adolescents and young adults [
42]. However, it seems that recent data have shown that the “good intention” did not protect young people better [
43‐
45]. On the other hand, sex education subjects are elective courses in Chinese universities. It is also possible that students who are interested in sexuality or have sexual experiences are more likely to choose the related subjects. Relationship between sex education and adolescents’ sexual behaviors is complex [
46]. What role does sex education play? The researchers agree with Pan’s point of view: “Sex education neither alone plays ‘fire extinguisher’ role, not functions as ‘accelerant’; the ultimate goal of sex education is to help all individuals, especially the next generation, enjoy a ‘happy sex life’ as much as possible [
46].” Namely, sex education should assist young people in developing a positive view of sexuality, provide them with information they need to take care of their sexual health, and help them acquire skills to make decisions now and in the future. However, considering China’s lack of an open and free social climate which normally plays a very important role in promoting sex education, it is very important to use the university system to introduce sexuality. Firstly, the university system appears to be a “safe” place or platform to incorporate debates and understandings of sexualities. Universities also have much more freedom to talk about sexuality than other places; therefore, debates can be deeper and more analytical. Furthermore, university students tend to be more open and to more easily adopt new ideas and perspectives on sexualities [
47].
Another factor correlated with sexual behaviors was educational aspiration for males. We found that education aspiration could negatively predicted male students’ sexual behaviors, namely the higher education aspiration, the less sexually active. The finding further confirmed prior studies that commitment to doing well in academic protected respondents from becoming sexually active and more sexual partners [
48]. Finally, time spent online was the last factor correlated with sexual behaviors for males. Our study found time spent online could slightly predict male students’ sexual behaviors, namely the longer surfing internet time, the more sexually active. But it couldn’t predict female students’ sexual behaviors. This may be because male students reported much higher rates of visiting pornographic websites, partner seeking and engaging online risky behaviors, which was closely associated with sexual behaviors including risky sexual behaviors [
49]. Appropriate guidance on their Internet use will be needed in China regarding the possible future impact of the Internet and pornographic media on the sexual behaviors of young people. For example, carefully monitoring and reducing online sexual risk behaviors among youth, especially males, and properly utilizing Internet as an informative source for sex education.
This study had several limitations. First, its cross-sectional design prevented us from identifying cause-and-effect associations, such as whether education aspiration decreased the prevalence of male students’ sexual behaviors could not be determined in this study. Second, the results obtained in this study should not be generalized to all Chinese young people or to all Chinese university students, since our sample was limited to university students within one capital city and socio-demographic characteristics are greatly diverse within Chinese provinces. Finally, the possible bias introduced by under-reporting should be noted. Measurements of sexual activity in this study were based on self-reports and participant sensitivity, especially female students, regarding sexual behavior may have led to under-reporting because of social desirability effect. Social desirability scale may be included in future survey.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
All authors contributed to the design of this research. XC and LY performed the statistical analysis and drafted the manuscript; XC was supervised by SW in the study idea and survey and SW also supervised the research, statistical analysis and revised the manuscript. All authors read and approved the final manuscript.