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National Survey of Sexual Attitudes and Lifestyles (Natsal)

National Survey of Sexual Attitudes and Lifestyles (Natsal)

Revealing the changing sexual attitudes and behaviour of the British population, Natsal is one of the largest scientific studies of sexual health and lifestyles in the world.

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About

The Natsal surveys have been carried out every 10 years since 1990. More than 45,000 people have been interviewed and the findings have helped to shape sexual and reproductive health policy in Britain.

Who we are

Natsal is led by a research team from the London School of Hygiene & Tropical Medicine, UCL and NatCen Social Research (NatCen).

Resources and publications

See results from the Natsal studies and download infographics to illustrate some of the key findings.

About
About Natsal

The National Survey of Sexual Attitudes and Lifestyles (Natsal) is one of the largest and most comprehensive studies of sexual behaviour and lifestyles in the world, and is a major source of data informing sexual and reproductive health policy in Britain.

The project is led by a research team from the London School of Hygiene & Tropical Medicine, UCL and NatCen Social Research (NatCen).

The survey has been carried out every 10 years since 1990, involving interviews with a total of 45,000 people. More than 15,000 adults aged 16-74 participated in the latest survey (Natsal-3) in 2010, and plans are now underway for Natsal-4.

Studying such a large representative sample of people living in Britain allows us to produce key estimates on patterns of sexual behaviour, attitudes, health, and wellbeing across the population. Results from Natsal-3 showed that different aspects of sexual health affect people at different times throughout their lives, and that sexual health is an important component of our overall health and wellbeing. They also revealed how sexual attitudes and lifestyles have changed in the last sixty years.

Lancet video of findings from the third National Survey of Sexual Attitudes and Lifestyles

Background

The first Natsal survey was conducted in 1990 in response to an urgent need for information about sexual practices in the context of the HIV/AIDS epidemic. A total of 18,876 men and women aged 16-59 years were interviewed. The survey provided much needed data to predict and prevent HIV transmission in Britain.

The data were used more widely than had been anticipated, by academics and practitioners in the fields of sexual health epidemiology, policy and practice.

Towards the end of the 1990s, new data were needed to investigate changes in sexual behaviour and to respond to demand for up-to-date information.

In response, Natsal-2 was carried out in 2000 and included 12,110 adults aged 16-44. The objectives of Natsal-2 were broader and it also aimed to provide a detailed understanding of patterns of sexual behaviour in Britain; provide data for HIV/AIDS projections in Britain; assess whether there had been changes in sexual behaviour since Natsal-1; and measure the prevalence of Chlamydia trachomatis infection, via the collection and analysis of urine samples.

Impact

Natsal findings play an important role in informing health policy in Britain. The studies provide valuable data for predicting and preventing HIV/STI transmission, and for improving our understanding of sexual and reproductive health. The data have been extensively used to design and promote sexual health education and services, and the methodology has been replicated elsewhere.

The studies have contributed to:

  • The National Sexual Health & HIV Strategy in England; the Scottish Sexual Health Strategy (2005-) and the Welsh Sexual Health Strategy
  • The Teenage Pregnancy Strategy (2000-2010)
  • The National Chlamydia Screening Programme (NCSP)
  • The national human papillomavirus (HPV) immunisation programme in 2008/9
  • The statutory provision of Personal, Social, Health & Economic (PHSE) education in schools in 2009
  • Sexual health campaigns, such as "Sex: worth talking about" in 2010
  • National Institute for Health and Clinical Excellence (NICE) guidelines on, for example, long acting contraception (2006)

Kaye Wellings discusses the findings from Natsal-3

About Natsal podcast
Resources & Publications
Resources
Publications
Painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey
Mitchell KR, Geary R, Graham CA, Datta J, Wellings K, Sonnenberg P, Field N, Nunns D, Bancroft J, Jones KG, Johnson AM, Mercer CH.
BJOG. 2017. doi: 10.1111/1471-0528.14518
Is "Sexual Competence" at First Heterosexual Intercourse Associated With Subsequent Sexual Health Status?
Palmer, MJ; Clarke, L; Ploubidis, GB; Mercer, CH; Gibson, LJ; Johnson, AM; Copas, AJ; Wellings, K; (2017)
Journal of sex research, 54 (1). pp. 91-104. ISSN 0022-4499 DOI: 10.1080/00224499.2015.1134424
Investigating the relationship between substance use and sexual behaviour in young people in Britain: findings from a national probability survey
Khadr SN, Jones KG, Mann S, Hale D, Johnson AM, Viner RM, Mercer CH*, Wellings K* (* joint senior authors).
BMJ Open, 2016 Jun 30; 6(6):e011961. doi: 10.1136/bmjopen-2016-011961
Men who have sex with men in Great Britain: comparing methods and estimates from probability and convenience sample surveys
Prah P, Hickson F, Bonell C, McDaid LM, Johnson AM, Wayal S, Clifton S, Sonnenberg P, Nardone A, Erens B, Copas AJ, Riddell J, Weatherburn P, Mercer CH.
2016. Sex Transm Infect. 92(6): 455-63
Sexual Function in 16- to 21-Year-Olds in Britain
Mitchell KR, Geary R, Graham C, Clifton S, Mercer CH, Lewis R, Macdowall W, Datta J, Johnson AM, Wellings K.
2016. J Adolesc Health. 59(4): 422-8
Trends in the use of emergency contraception in Britain: evidence from the second and third National Surveys of Sexual Attitudes and Lifestyles
Black KI, Geary R, French R, Leefe N, Mercer CH, Glasier A, Macdowall W, Gibson L, Datta J, Palmer M, Wellings K.
2016. BJOG. 123(10): 1600-7
Actual and preferred contraceptive sources among young people: findings from the British National Survey of Sexual Attitudes and Lifestyles
Geary RS, Tomes C, Jones KG, Glasier A, Macdowall W, Datta J, Sonnenberg P, Wellings K, French RS, Mercer CH, Johnson AM.
2016. BMJ Open. 6(9):e011966
Salivary testosterone levels and health status in men and women in the British general population: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)
Clifton S, Macdowall W, Copas AJ, Tanton C, Keevil BG, Lee DM, Mitchell KR, Field N, Sonnenberg P, Bancroft J, Mercer CH, Wallace AM, Johnson AM, Wellings K, Wu F
J Clin Endocrinol Metab.2016. Aug 23:jc20161669
How can we objectively categorise partnership type? A novel classification of population survey data to inform epidemiological research and clinical practice
Mercer CH, Jones KG, Johnson AM, Lewis R, Mitchell KR, Gravningen K, Clifton S, Tanton C, Sonnenberg P, Wellings K, Cassell JA, Estcourt CS
Sex Transmit Infect. 2016. doi:10.1136/sextrans-2016-052646
The health and well-being of men who have sex with men (MSM) in Britain: Evidence from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)
Mercer CH, Prah P, Field N, Tanton C, Macdowall W, Clifton S, Hughes G, Nardone A, Wellings K, Johnson AM, Sonnenberg P
BMC Public Health. 2016; 16(1); DOI: 10.1186/s12889-016-3149-z
Prevalence of infertility and help seeking among 15000 women and men
Datta J, Palmer MJ, Tanton C, Gibson LJ, Jones KG, Macdowall W, Glasier A, Sonnenberg P, Field N, Mercer CH, Johnson AM, Wellings K
Hum Reprod. 2016; 31(9); 2108-2118
Forming new sex partnerships while overseas: findings from the third British National Survey of Sexual Attitudes & Lifestyles (Natsal-3)
Tanton C, Johnson AM, Macdowall W, Datta J, Clifton S, Field N, Mitchell KR, Wellings K, Sonnenberg P, Mercer CH
Sex Transmit Infect. 2016; doi:10.1136/sextrans-2015-052459
Changes in conceptions in women younger than 18 years and the circumstances of young mothers in England in 2000-12: an observational study
Wellings K, Palmer MJ, Geary RS, Gibson LJ, Copas A, Datta J, Glasier A, Scott RH, Mercer CH, Erens B, Macdowall W, French RS, Jones K, Johnson AM, Tanton C, Wilkinson P
Lancet 2016; doi: 10.1016/S0140-6736(16)30449-4
Are depression and poor sexual health are neglected co-morbidities? Evidence from a population sample
Field N, Prah P, Mercer CH, Rait G, King M, Cassell, J, Tanton C, Heath L, Mitchell KR, Clifton S, Datta J, Wellings K, Johnson AM, Sonnenberg P
BMJ Open 2016; 6(3) e010521-?. doi:10.1136/bmjopen-2015-010521
HIV testing, risk perception, and behaviour: findings from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3)
Clifton S, Nardone A, Field N, Mercer CH, Tanton C, Macdowall W, Johnson AM, Sonnenberg P
AIDS 2016; 20(6); 943-951
Medicated sex in Britain: evidence from the third National Survey of Sexual Attitudes and Lifestyles
Mitchell, KR; Prah, P; Mercer, CH; Datta, J; Tanton, C; Macdowall, W; Copas, AJ; Clifton, S; Sonnenberg, P; Field, N; Johnson, AM; Wellings, K; (2016)
Sexually transmitted infections, 92 (1). pp. 32-8. ISSN 1368-4973 DOI: 10.1136/sextrans-2015-052094
Burkill S, Copas A, Couper MP, Clifton S, Prah P, Datta J, Conrad F, Wellings K, Johnson AM, Erens B
Using the web to collect data on sensitive behaviours: a study looking at mode effects on the British National Survey of Sexual Attitudes and Lifestyles
PLoS ONE 11(2): e0147983.doi:10.1371/journal.pone.0147983
Experience and Meaning of Genital Symptoms to People in Britain: Findings from the Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)
Mapp F, Hickson F, Mercer CH, Wellings K
The Journal of Sexual Medicine, 2015; 12. p. 320. ISSN 1743-6095
Prevalence of sexual function problems in Britain: The impact of morbidity criteria
Mitchell KR, Jones KG, Wellings K, Johnson AM, Graham C, Datta J, Copas AJ, Bancroft J, Sonnenberg P, Macdowall W, Field N, Mercer CH
(2015) Journal of Sex Research; DOI: 10.1080/00224499.2015.1089214
Examining the association between male circumcision and sexual function: Evidence from a British probability sample survey
Homfray V, Tanton C, Mitchell K, Miller R, Field N, Macdowall W, Wellings K, Sonnenberg P, Johnson A, Mercer CH (2015)
AIDS 29:1411–1416
Epidemiology of Mycoplasma genitalium in British men and women aged 16-44 years: evidence from the third National Survey of Sexual Attitudes and Lifestyles
Sonnenberg P, Ison CA, Clifton S, Field N, Tanton C, Soldan K, Beddows S, Alexander S, Khanom R, Saunders P, Copas AJ, Wellings K, Mercer CH, Johnson AM
International Journal of Epidemiology 2015; 1-13. doi: 10.1093/ije/dyv194
Asking about sex in general health surveys: Comparing data collected by the Health Survey for England with the National Survey of Sexual Attitudes and Lifestyles
Prah P, Johnson AM, Nardone A, Clifton S, Mindell JS, Copas AJ, Robinson C, Craig R, Woodhall S, Macdowall W, Fuller E, Erens B, Sonnenberg P, Wellings K, Mercer CH
PLOS ONE, 2015;10(8):e0135203 doi: 10.1371/journal.pone.0135203
Natsal-3: key findings from Scotland
Fuller E, Clifton S, Field N, Mercer CM, Prah P, Macdowall W, Mitchell K, Sonnenberg P, Johnson AM, Wellings K
Scottish Government, 2015
Tanton C, Soldan K, Beddows S, Mercer CH, Waller J, Field N, Clifton S, Copas AJ, Panwar K, Manyenga P, Coelho da Silva F, Wellings K, Ison CA, Johnson AM, Sonnenberg P
High-risk human papillomavirus (HPV) infection and cervical cancer prevention in Britain: Evidence of differential uptake of interventions from a national probability survey
Cancer Epidemiology, Biomarkers, and Prevention. 2015; 24(5) 842-53
Patterns and trends in sources of information about sex among young people in Britain: evidence from three National Surveys of Sexual Attitudes and Lifestyles
Tanton C, Jones KG, Macdowall W, Clifton S, Mitchell KR, Datta J, Lewis R, Field N, Sonnenberg P, Stevens A, Wellings K, Johnson AM, Mercer CH
BMJ Open. 2015; 5: e007834. doi:10.1136/bmjopen-2015-007834
Associations between source of information about sex and sexual health outcomes in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)
Macdowall W, Jones KG, Tanton C, Clifton S, Copas AJ, Mercer CH, Palmer MJ, Lewis R, Datta J, Mitchell KR, Field N, Sonnenberg P, Johnson AM, Wellings K
BMJ Open. 2015; 5:e007837. doi:10.1136/bmjopen-2015-007837
Confirmatory assays are essential when testing for Neisseria gonorrhoeae in low prevalence settings: Insights from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)
Field N, Clifton S, Alexander S, Ison CA, Hughes G, Beddows S, Tanton C, Soldan K, Coelho da Silva F, Mercer CH, Wellings K, Johnson AM, Sonnenberg P
Sexually Transmitted Infections. Published online first doi:10.1136/sextrans-2014-051850
The Natsal-SF Measure of Sexual Function: Comparison of Three Scoring Methods
Jones KG, Mitchell KR, Ploubidis GB, Wellings K, Datta J, Johnson AM, Mercer CH
Journal of Sex Research. 2015; DOI: 10.1080/00224499.2014.985813
Nonprobability web surveys to measure sexual behaviours and attitudes in the general population: a comparison with a probability sample interview survey
Erens B, Burkill S, Couper MP, Conrad F, Clifton S, Tanton C, Phelps A, Datta J, Mercer CH, Sonnenberg S, Prah P, Mitchell KR, Wellings K, Johnson AM, Copas AJ
Journal of Medical Internet Reseach. 2014;16(12):e276
The prevalence of, and factors associated with, paying for sex among men resident in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)
Jones KG, Johnson AM, Wellings K, Sonnenberg S, Field N, Tanton C, Erens B, Clifton S, Datta J, Mitchell KR, Prah P, Mercer CH
Sex Transm Infect. 2014; Published Online First: 17 November 2014. doi:10.1136/sextrans-2014-051683
Salivary testosterone measurement by liquid chromatography tandem mass spectrometry in adult males and females
Keevil BG, MacDonald P, Macdowall W, Lee DM, Wu FCW and the NATSAL Team
Ann Clin Biochem.2014; 51:368-378
What’s new about Natsal-3?
Mercer CH, Wellings K, Johnson AM
Sex Transm Infect. 2014; 90: 80-81
Methodology of the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3)
Erens B, Phelps A, Clifton S, Mercer CH, Tanton C, Hussey D, Sonnenberg P, Macdowall W, Field N, Datta J, Mitchell K, Copas AJ, Wellings K, Johnson AM
Sex Transm Infect. 2014; 90: 84-89
Consistency in reporting sensitive sexual behaviours in Britain: Change in reporting bias in the second and third National Surveys of Sexual Attitudes and Lifestyles (Natsal-2 and Natsal-3)
Prah P, Copas AJ, Mercer CH, Clifton S, Erens B, Phelps A, Tanton C, Sonnenberg P, Macdowall W, Wellings K, Johnson AM
Sex Transm Infect. 2014; 90: 90-93
Framing sexual health research: adopting a broader perspective
Wellings K, Johnson AM
Lancet. 2013; 382: 1759-1761
Changes in sexual attitudes and lifestyles through the lifecourse and trends over time: Findings from the British National Surveys of Sexual Attitudes and Lifestyles (Natsal)
Mercer CH, Tanton C, Prah P, Erens B, Sonnenberg P, Clifton S, Macdowall W, Lewis R, Field N, Datta J, Copas AJ, Phelps A, Wellings K, Johnson AM
Lancet. 2013; 382: 1781-1794
Prevalence, risk factors and uptake of interventions for sexually transmitted infections: Findings from the British National Surveys of Sexual Attitudes and Lifestyles (Natsal)
Sonnenberg P, Clifton S, Beddows S, Field N, Soldan K, Tanton C, Mercer CH, Coelho da Silva F, Alexander S, Copas AJ, Phelps A, Erens B, Prah P, Macdowall W, Wellings K, Ison CA Johnson AM
Lancet. 2013; 382: 1795-1806
Unplanned pregnancy in Britain: prevalence, associated factors and context; findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal 3)
Wellings K, Jones KG, Mercer CH, Tanton C, Clifton S, Datta J, Copas AJ, Erens B, Gibson LJ, Macdowall W, Sonnenberg P, Phelps P, Johnson AM
Lancet. 2013; 382: 1807-1816
Sexual function in Great Britain: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal)
Mitchell KR, Mercer CH, Ploubidis GB, Jones KG, Datta J, Field N, Copas AJ, Tanton C, Erens B, Sonnenberg P, Clifton S, Macdowall W, Phelps A, Johnson AM, Wellings K
Lancet. 2013; 382: 1817-1829
Investigating associations between health and sexual lifestyles: Findings from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3)
Field N, Mercer CH, Sonnenberg P, Tanton C, Clifton S, Mitchell KR, Erens B, Macdowall W, Wu FC, Datta J, Jones KG, Stevens A, Prah P, Copas AJ, Phelps A, Wellings K, Johnson AM
Lancet. 2013; 382: 1830-1844
Lifetime prevalence, associated factors and circumstances of non-volitional sex among women and men: Findings from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal)
Macdowall W, Gibson LJ, Tanton C, Mercer CH, Lewis R, Clifton S, Field N, Datta J, Mitchell KR, Sonnenberg P, Erens B, Copas AJ, Phelps A, Prah P, Johnson AM, Wellings K
Lancet. 2013; 382: 1845-1855
The Natsal-SF: a validated measure of sexual function for use in community surveys
Mitchell KR, Ploubidis GB, Datta J, Wellings K
Eur J Epidemiol. 2012; 27(6): 409-18
A Liquid Chromatography-Tandem Mass Spectrometry Method for Salivary Testosterone with Adult Male Reference Interval Determination
Macdonald PR, Owen LJ, Wu FC, MacDowall W, Keevil BG For the NATSAL team
Clin Chem. 2011; 57:774-775
Distribution of salivary testosterone in men and women in a British general population-based sample: the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)
Keevil, BG, Clifton S, Tanton C, Macdowall W, Copas AJ, Lee D, Field N, Mitchell KR, Sonnenberg P, Bancroft J, Mercer CH, Johnson AM, Wellings K, Wu, FCW
Journal of the Endocrine Society. 2017. 1(1); 14-25
Use of the internet for sexual health among sexually experienced persons aged 16 to 44 years: Evidence from a nationally representative survey of the British population
Aicken CRH, Estcourt CS, Johnson AM, Sonnenberg P, Wellings K, Mercer CH
Journal of Medical Internet Research, 2016; 18(1):e14. doi: 10.2196/jmir.4373
Updates
Updates List Block
Nearly one in 10 British women experience painful sex linked to poorer sexual, physical and mental health

Nearly one in 10 British women are experiencing painful sex (dyspareunia), according to a new study published in BJOG: An International Journal of Obstetrics and Gynaecology.

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Distressing sexual problems reported by at least one in ten young people in Britain

Around one in ten young men and one in eight young women in Britain who are sexually active have experienced a distressing sexual problem lasting at least three months in the past year, according to new research published in the Journal of Adolescent Health.

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Nearly half of women and men do not seek medical help for infertility

One in eight women and one in ten men have experienced infertility, yet nearly half of them have not sought medical help, according to a study of more than 15,000 women and men in Britain published in the journal Human Reproduction.

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Substantial numbers of British adults find new sexual partners while travelling abroad

The authors of the study published in Sexually Transmitted Infections call for safer sex information to be routinely provided in pre-departure travellers’ health advice regardless of age, destination or reason for travel.

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1.8 million adults in Britain experience severe sexual problems

An estimated 1.8 million adults in Britain are experiencing sexual problems that need medical help but only around one third of these men and women seek professional support, according to new research published in the Journal of Sex Research.

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New research highlights differences in how young men and women learn about sex and relationships

More young people than ever are getting most of their information about sexual matters from school, but the majority feel they are not getting all the information they need, and men in particular are missing out, according to new research published in BMJ Open.

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1 in 10 British men say they have paid for sex

11% of men in Britain report having ever paid for sex and 3.6% report doing so in the past five years, according to findings published in Sexually Transmitted Infections.

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Results from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Results published The Lancet give the most detailed picture yet of the British population’s sex lives over the last 10 years.

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Who we are
Who we are Natsal

Natsal is led by a research team from the London School of Hygiene & Tropical Medicine, UCL and NatCen Social Research (NatCen). School researchers working on the project:

Team Block

Kaye Wellings

Professor

Melissa Palmer

Research Fellow

Bob
Erens

Associate Professor