Sexual health indicators for the United States: Measuring progress and documenting public health needs

Advancing a Measure of Sexual and Reproductive Well-Being Aligned With Core Values of Reproductive Justice and Human Rights

Sexuality and reproduction are central to people's life experiences and their ability to thrive. Existing frameworks and measurements related to sexuality and reproduction are predominantly focused on the presence or absence of adverse outcomes, neglecting the critical question of whether people experience positive outcomes and have the sexual and reproductive lives they wish to have. The increased attention to well-being in economic, political, and health spheres presents an opportunity to define and measure the holistic construct of sexual and reproductive well-being. To this end, we engaged in an 18-month collaborative process to develop a definition of sexual and reproductive well-being, with the ultimate goal of informing the development of a measure that would be self-reported and assessed at the population level. The resulting draft definition and measure development approach will serve as the foundation for subsequent measure development. This values-driven process of defining sexual and reproductive well-being will contribute to developing a reproductive justice- and human rights-aligned measure that can illuminate the extent to which structures and systems enable optimal sexual and reproductive experiences. (Am J Public Health. Published online ahead of print May 22, 2025:e1-e9. https://doi.org/10.2105/AJPH.2025.308119).

Developing socio-epidemiological indicators of sexual health among migrant population in Chile

BACKGROUND

Monitoring and responding to the sexual health needs of migrants is crucial, given their vulnerability during migration. Therefore, this study aimed to develop socio-epidemiological indicators related to sexual health and communicable diseases among the migrant population in Chile, including dimensions of the contexts of vulnerability and migratory trajectories.

METHOD

We used a mixed methodology within the framework of implementation research and community-based research based on qualitative data, secondary sources, and expert judgment to construct socio-epidemiological indicators related to sexual health among the migrant population in Chile, including vulnerability and migration trajectories. Preliminary indicators were defined. First, qualitative data were collected through semi-structured interviews with individuals of migrant origin and focus groups with members of community-based organizations, primary healthcare providers, and experts. These instruments were then complemented with indicators from secondary sources. The set of indicators was subjected to content validation and ranking through Delphi Groups and expert judgment, ending with validation through a field pilot test.

RESULTS

The result was a definitive instrument that included 94 indicators, distributed into 73 questions that correspond to the following dimensions: sociodemographic background, migratory history, and contexts of vulnerability, violence, connection with the Chilean health system, sexual practices, sex work, sexual health (including HIV and STIs) and access to sexual health services, and sexual health needs.

CONCLUSION

Participation of the target population and key actors allowed for consensus on a highly sensitive data collection instrument since its indicators account for the contexts of vulnerability and key structural aspects to address sexual health among migrants from an intersectional perspective.

Associations Between Gender and Sexuality Characteristics of Cisgender Bisexual Women and Risk of Sexual Assault

Objective

Research consistently documents disproportionately high rates of sexual assault among bisexual women, one of the fastest growing sexual minority demographic groups in the United States. This study seeks to better understand how bisexual women's position as both women and sexual minority people may heighten their risk for sexual assault.

Method

Using data from 165 bisexual women in the Chicago Health and Life Experience of Women (CHLEW) study, we examine associations between the gender and sexuality characteristics of self-identifying cisgender bisexual women and sexual assault.

Results

We found that the risk of experiencing sexual assault, including rape, is associated with past experiences of bi-stigma, earlier age of recognizing bisexual identity, gender discrimination, and a less masculine gender presentation.

Conclusion

Our findings suggest that bisexual women are targeted in specific overlapping sexist, bi-phobic and stereotypical ways that may leave them particularly vulnerable to sexual assault. This study highlights the need for more research that investigates how bisexual women's high rates of sexual assault are shaped by oppressive systems and social forces related to their gender and sexuality.

The Gender Gap in Partnered Orgasm: A Scoping Review of Evidence with Graphical Comparisons

This article provides a review and visualization of findings over the last 30 years related to the orgasm gap between men and women in heterosexual encounters. We describe and compare techniques commonly used for measuring orgasm occurrence and frequency patterns, and we summarize the contrast in orgasm rates shown in these studies across different behavior sets and social contexts. Of central importance, women's orgasm rates increase dramatically with the inclusion of behaviors that provide specific stimulation to the clitoris, revealing this gap is largely driven by social dynamics rather than strictly biological mechanisms. Disparities between men and women are especially pronounced in contexts with low levels of partnered sexual experience, partner familiarity, and relationship commitment. Women are also more likely to experience orgasm when masturbating or partnered with women than when partnered with men. Ultimately, we echo calls for a biopsychosocial approach to sexual enjoyment and well-being, and we provide recommendations for future research, including increased precision in measurement and reporting, diversifying sampling concentrations, and assessing life course trajectories.

A call for sex-positive epidemiology

The World Health Organization specifies that sexual health requires the potential for pleasurable and safe sexual experiences. Yet epidemiologic research into sexual pleasure and other positive sexual outcomes has been scant. In this commentary, we aim to support the development and adoption of sex-positive epidemiology, which we define as epidemiology that incorporates the study of pleasure and other positive features alongside sexually transmitted infections and other familiar negative outcomes. We first call epidemiologists' attention to the potential role that stigma plays in the suppression of sex-positive research. We further describe existing measures of sex-positive constructs that may be useful in epidemiologic research. Finally, the study of sex-positive constructs is vulnerable to biases that are well-known to epidemiologists, especially selection bias, information bias, and confounding. We outline how these biases influence existing research and identify opportunities for future research. Epidemiologists have the potential to contribute a great deal to the study of sexuality by bringing their considerable methodological expertise to long-standing challenges in the field. We hope to encourage epidemiologists to broaden their sexual health research to encompass positive outcomes and pleasure.

A Contextualization of Transgender Women and Condom Use Using the HIV Syndemic Framework: Scoping Review

Objective: To contextualize condom use in the transgender women population utilizing the HIV syndemic framework. Methods: Studies reporting condom use frequency and syndemic factors associated with HIV risk in transgender women were systematically searched. We followed the Scoping Reviews (PRISMA-ScR) checklist. Results: Social factors have a proven relationship with using condoms and HIV among transgender women. Syndemic factors, defined as co-occurring adverse factors that interact to contribute to risk behaviors, deserve a specific analysis to develop strategies to face HIV among transgender women. Conclusions: A syndemic perspective allows to generate specific health intervention and prevention policies to protect transgender women.