Survey takes a close look at evolving patterns in sexual frequency, preferences, and the use of contraception.

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Sexual attitudes and behaviors may be marked by different factors, such as generations, media influences, and culture. Have you ever wondered how these attitudes and behaviors have changed in the United States?

If so, results from a national survey may answer some of your questions.

The National Survey of Sexual Health and Behavior (NSSHB) — the largest probability survey dedicated to understanding sexual behaviors in the United States — has been asking people a wide range of questions about their sex lives since 2009.

The survey, conducted by researchers at The Center for Sexual Health and Promotion at Indiana University in Bloomington, covers topics including frequency of sexual activity, preference in sexual partners, contraception use, and pleasure rates during sex.

Rather than a one-time questionnaire, the NSSHB has compiled data in waves since 2009. All the information gathered has been published in more than 30 manuscripts. The last one of these was released in 2019.

In total, more than 20,000 people between ages 14 and 102 have participated in the NSSHB.

Some of the NSSHB key findings from 2009 to 2018 include:

Variety in sexual activities

The NSSHB showed that U.S. adults reported “enormous variability in their sexual repertoires,” with more than 40 combinations of sexual activity described as their most recent sexual encounter.

Males are more likely to orgasm when sex includes vaginal intercourse. Females orgasm more when they engage in a variety of sex acts and when oral sex or vaginal intercourse is included in these acts.

Perception of satisfaction varies

This may come as no surprise to cisgender women, but the national sex survey suggests their male partners can be poor judges of their sexual satisfaction. About 85% of men report that “their partner had an orgasm at their most recent sexual event” — compared to “64% of women who reported having an orgasm” at their most recent sexual event.

Attitudes toward bisexual individuals

Gender also seems to play an important role in “understanding attitudes toward bisexual individuals among heterosexual, gay/lesbian, and other-identified adults.”

Overall, the NSSHB shows that women are more likely than men to report “positive attitudes toward bisexual individuals.” Attitudes toward bisexual women are also “more positive than attitudes toward bisexual men.”

Older adults are active, too

Older U.S. adults are not necessarily slowing down when it comes to sex.

The misconception that they don’t maintain regular sexual activity seems to be disproven. Survey findings indicate that older adults continue to have robust sex lives, reporting a range of different behaviors and partner types.

In fact, another survey conducted in 2018 by the Institute for Healthcare Policy and Innovation at the University of Michigan had similar findings when studying sexual activity among older adults in the United States.

When adults ages 65 to 80 were asked about their sexual experiences, 76% reported sex is an important part of a romantic relationship at any age. Also, 54% of older adults who were in a romantic relationship reported being sexually active, while 40% of overall participants reported that they are currently having sex.

Although generational differences do exist, they may not be as significant as they once were, says Azaria Davis, a licensed master social worker, and therapist in Gaithersburg, Maryland.

“While younger people may be known for being open to sexual exploration, older Americans are exploring as well, but they may not be talking about it as openly,” says Davis, who works with individuals and partners on intimacy and sexuality issues. “For older people, privacy concerns often come up when talking about their sexual activity. “

Davis adds that these findings show how intimacy is a need that people crave at all stages of life. “There was often this notion that as people age, they are looking for less intimacy and connection, but this is not really true.”

The National Survey of Sexual Health and Behavior also revealed surprising trends between 2009 and 2018 that highlight changes during these years in sexual attitudes and behaviors among U.S. adults.

Kissing during sexual encounters may become a thing of the past

While most of the NSSHB respondents reported kissing 87% of the time during sexual encounters, participants under age 30 were “significantly more likely” to report that they did not kiss during sex. The main reason attributed to this was that kissing would have been “too intimate.”

About these results, Sari Cooper, a certified sex therapist in New York City, explains that avoiding kissing may be a way of protecting yourself from getting too invested in another person. It may also be a response to ensure the relationship and expectations remain casual.

But Cooper also cautions that sometimes an avoidance of intimacy can increase feelings of isolation and loneliness.

Younger adults may benefit from support on how to navigate and manage feelings around intimacy. “The avoidance of emotional closeness for younger people is an issue that I feel we need to help young folks with,” Cooper states.

Adults over age 40 have the lowest rates of condom use

The NSSHB reports over the years have shown a condom use decline in this age group — something that may be surprising at first glance.

Davis says the decrease in contraceptive use may be connected to the diminished avoidance of unintended pregnancy that may come with age.

“For some people over 40, using protection was about not getting pregnant, but as pregnancy risk declines, some may underestimate the continued risk of sexually transmitted infections,” she says.

Experts stress the importance of continued protection against sexually transmitted infections in all age groups.

Condom use no longer a perceived barrier to sexual pleasure

When asked about condom use, NSSHB participants ages 18 to 59 were just as likely to rate a sexual encounter as pleasurable when they wore a condom than when they didn’t. This may indicate a potential shift in the previous perception that sexual pleasure decreases with condom use.

Research published in 2007 on this issue also has found that sexually active adults tended to rate sexual experiences as less pleasurable when a condom is worn.

Sex rates of partnered people

Despite some cultural perceptions that sex can dwindle in long-term relationships — and that those flying solo may have more sexual encounters — the NSSHB reports show that partnered adults ages 18 to 59 have sexual intercourse 4 times as often as their single counterparts.

Open relationships more common now

Consensual, nonmonogamous relationships have become more common, according to the NSSHB results.

Among NSSHB participants who reported being in romantic relationships:

  • 89% said they were in a monogamous partnership
  • 8% reported having sexual relations with someone who was not their partner
  • 4% reported open relationships (also referred to as consensual nonmonogamy)

While 4% of the population engaging in open relationships may not seem like a significant amount, it may indicate a growing number.

The National Survey of Sexual Health and Behavior is the largest probability survey in the United States focused on understanding sexual behaviors and attitudes of U.S. adults. Data has been collected in waves since 2009 and more than 20,000 people ages 14 to 102 have been surveyed.

You can learn more about the survey’s publications on this page.