Introduction. This is a report of a cross-sectional study on paraphilia-associated sexual arousal patterns (PASAP) among men in a metropolitan city in Germany, EU. Aim. To determine the prevalence of PASAP during sexual fantasies, fantasies accompanying masturbation, and real-life sociosexual behavior. Methods. In a cross-sectional study, self-reported sexual history data were collected by questionnaire from 367 volunteers recruited from a community sample of 1,915 men aged 40-79 years. Main Outcome Measures. The Derogatis Symptom Checklist-Revised (SCL-90-R) and the Life Satisfaction Questionnaire (LSQ; German original, Fragebogen zur Lebenszufriedenheit,[FLZ]) were administered to obtain a general subjective health measure and a measure of general as well as sex life satisfaction. The Questionnaire on Sexual Experiences and Behaviour was administered to comprehensively assess all relevant sexo-medical data. Results. The percent of men that reported at least one PASAP was 62.4%. In 1.7% of cases, PASAP were reported to have caused distress. The presence of PASAP was associated with a higher likelihood of being single (odds ratio [OR] 2.6; 95%; confidence interval [CI] 1.047-6.640), masturbating at least once per week (OR 4.4; 95%; CI 1.773-10.914), or having a low general subjective health score (OR 11.9; 95%; CI 2.601-54.553). Pedophilic PASAP in sexual fantasies and in real-life sociosexual behavior was reported by 9.5% and 3.8% of participants, respectively. Conclusion. The findings suggest that paraphilia-related experience can not be regarded as unusual from a normative perspective. At the same time, many men experience PASAP without accompanying problem awareness or distress, even when PASAP contents are associated with potentially causing harm to others. In view of the relevance for sex life and relationship satisfaction, presence of PASAP should be assessed in all sexual medicine consultations. Future research should focus on conditions in which PASAP reach clinical significance in the sense of mental disorders. Ahlers CJ, Schaefer GA, Mundt IA, Roll S, Englert H, Willich SN, and Beier KM. How unusual are the contents of paraphilias? Paraphilia-associated sexual arousal patterns in a community-based sample of men. J Sex Med **;**:**-**.

I reviewed the empirical literature for 1980-2008 on exhibitionism, voyeurism, and frotteurism for the American Psychiatric Association's Sexual and Gender Identity Disorders Work Group in preparation for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Very limited empirical support was found for major changes of the current DSM-IV-TR criteria sets for these paraphilias. Some of the criticism of current criteria and the balancing of false negatives and false positive diagnoses are examined. The report concludes with suggestions for possible diagnostic criteria changes for the DSM-V.

OBJECTIVE: To review the content, method and process of the Australian Study of Health and Relationships (ASHR). RESULTS: ASHR achieved a large sample, a high response rate and documented the sexual life histories and current sexual health-related knowledge, attitudes and practices of the Australian population aged 16-59. Its cross-sectional nature limited our ability to partition observed variation between age and time despite clear evidence of both age-related and cohort-related changes in sexual practice. Similarly, its reliance on a sample of individuals reporting on their sexual experiences rather than a sample of sexual relationships or encounters and their participants limits our ability to understand the dynamics of those relationships and encounters. Finally, our understanding of sexuality in Australia could have been improved through qualitative studies with a subsample of ASHR participants. CONCLUSION: ASHR represents a significant contribution to our understanding of sexual health-related knowledge, attitudes and practices in Australia.

OBJECTIVE: Some blood-borne and sexually transmissible agents may be spread by using non-sterile injecting equipment and by unprotected sexual intercourse. The objective of this study was to describe the prevalence of these risk factors in the general population of Australia. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The overall response rate was 73.1%(69.4% men, 77.6% women). RESULTS: 3% of respondents had ever injected non-prescription drugs; men were more likely than women to have done so. Predictors of injecting in men and women included being aged 20-29, homosexual or bisexual identity, and lower levels of education and income. Injecting was not more common in cities than elsewhere. Among people who had injected in the past year, 12.4% had shared needles and 43.0% had shared other paraphernalia. Sharing was significantly related to lower income. Unprotected sex with casual partners was more common in heterosexual activity than in male homosexual activity. Among heterosexually active respondents, 3.3% reported unprotected vaginal sex with casual partners (59% of those with such partners) and among homosexually active males 2.1% reported unprotected anal sex with casual partners (12% of those with such partners). Predictors of unprotected sex included indices of lower socio-economic status. CONCLUSION: Sexual and injecting risks are reported by substantial minorities of the Australian population and are associated with indices of lower socio-economic status and bisexual identity. Programs are needed to address vulnerabilities to these infections.

OBJECTIVE: To describe the lifetime and recent history of STIs and BBV, including place of seeking treatment, in a representative sample of Australian adults. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The overall response rate was 73.1%(69.4% among men and 77.6% among women). RESULTS: Overall, 20.2% of men and 16.9% of women had ever been diagnosed with an STI or BBV, and 2.0% and 2.2% respectively had been diagnosed in the past year. The participant's usual general practitioner was the most common location of treatment. Sexual health clinics accounted for a small proportion of treatment locations. Predictors of recent STI or BBV diagnosis in men included homosexual or bisexual identity, a history of sex work as a worker or client, a history of injecting drugs and having more than one partner in the past year. In women, predictors included bisexual identity, history of sex work as a worker, injecting drug use, and having more than one partner in the past year. Around 40% of men and women had been tested for HIV and in homosexually identified men, 77% had been tested. CONCLUSION: STIs and BBVs are common infections in Australia and care is mostly received from general practitioners. Although a variety of predictors, including homosexual or bisexual identity, injecting drug use and sex work were related to STI diagnosis, STIs were not uncommon among people without these risk factors. IMPLICATIONS: General practitioners in Australia require a high level of expertise to recognise, offer testing, and manage common STIs and BBVs.

OBJECTIVE: To describe knowledge related to sexually transmitted infection (STI) and blood-borne virus (BBV) infection in a representative sample of Australian adults. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The overall response rate was 73.1%(69.4% among men and 77.6% among women). Respondents were read a series of statements about STIs and BBVs and asked to say if they believed they were true or false. Predictors of knowledge were examined. RESULTS: Respondents were more likely to answer correctly questions about hepatitis C than questions about herpes, gonorrhoea, genital warts and chlamydia. Women had better knowledge than men. Other predictors of better knowledge included speaking English at home, homosexual or bisexual identity, higher educational levels, higher income, higher occupational level and a previous STI diagnosis. CONCLUSION: Knowledge of transmission routes and health consequences of the most common STIs was poor. Although knowledge is only one prerequisite for effective disease prevention, the findings suggest that improving public knowledge of STIs is an urgent task in reducing the morbidity associated with these common infections. IMPLICATIONS: Education campaigns to increase knowledge of the transmission and health consequences of STIs are urgently required if the substantial morbidity associated with these common infections is to be reduced.

OBJECTIVE: To provide reliable estimates of the frequency of condom use and correlates of condom use among Australian adults. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The response rate was 73.1%(69.4% men, 77.6% women). RESULTS: Although the majority of respondents had used a condom at some time in their lives, fewer than half of the respondents who were sexually active in the year before being interviewed had used a condom in the past year. Condom use in the past year was associated with youth, greater education, residence in major cities, lower incomes, white-collar occupations, being a former smoker, and having more sexual partners in the past year. In the six months prior to interview, 7.1% of respondents always used condoms with regular cohabiting partners, 22.5% always used condoms with regular non-cohabiting partners, and 41.4% always used condoms with casual partners. Approximately 20% of respondents used a condom the last time they had vaginal intercourse, and one in eight of these condoms were put on after genital contact. Condom use during the most recent sexual encounter was associated with youth, living in a major city, having a lower income, having sex with a casual partner, and not using another form of contraception. CONCLUSION: As in other studies, condom use was strongly associated with partner type and use of other contraception. IMPLICATIONS: People with multiple sexual partners need to be aware that non-barrier methods of contraception (and condoms applied late) do not protect against sexually transmitted infections.

OBJECTIVE: Condom use is a central part of strategies to prevent the transmission of human immunodeficiency virus and other sexually transmissible infections. The objective of this study was to provide reliable estimates of the prevalence and correlates of condom failure among a representative sample of Australian men. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men aged 16-59 years from all States and Territories. The response rate was 69.4%. RESULTS: Among men who used condoms in the year prior to being interviewed, 23.8% experienced at least one condom breakage in the past year and 18.1% experienced at least one condom slippage in the past year. Experience of condom breakage in the past year was significantly related to younger age, having a blue-collar occupation, and using more condoms. Neither condom slippage nor condom failure was significantly related to use of water-based lubricants or oil-based lubricants. CONCLUSION: Condom failure is related to certain characteristics of individuals and is not randomly distributed across all condom users. Lubricant use did not affect condom failure. IMPLICATIONS: There may not be a need to promote lubricant use for vaginal intercourse, as there was no association between lubricant use and condom failure.

OBJECTIVES: To document the use of contraception by a representative sample of Australian women aged 16-59 years. METHOD: Between mid-2001 and mid-2002, computer-assisted telephone interviews were completed by 9,134 women aged 16-59 years from all States and Territories selected by modified random-digit dialling of households (response rate 77.6%). Respondents were asked about contraceptive methods used in their current regular relationship(s) and during recent sexual encounters, or in general, or their reasons for non-use. Responses were allocated to 14 categories. RESULTS: 70.8% of respondents were using a method of contraception, over 95% of those apparently at risk of pregnancy. Most common reasons for non-use were not having intercourse (41.6%) and being past menopause (21.6%). Among those apparently at risk of unplanned pregnancy (i.e. who were heterosexually active and fertile but not pregnant or trying to become pregnant; 13.0% of non-users), the most common reasons for non-use were experience of side-effects or contra-indications (23.0%), leaving it to chance (20.2%), forgetting/not caring (18.9%), breast feeding (16.5%) and believing it unnatural/unhealthy (13.7%). No women cited religious objections or lack of access to services. The most used methods were oral contraceptives (33.6% of users), tubal ligation/hysterectomy (22.5%), condom (21.4%) and vasectomy of partner (19.3%). Tubal ligation rates were higher and condom use lower in regional and remote areas. CONCLUSION: Given the high levels of use and knowledge and lack of evidence of unmet service need, most unplanned pregnancies in Australian adults are likely to be attributable to method failure or inconsistent use.

OBJECTIVE: To document the reproductive experiences of a representative sample of Australian women aged 16-59 years. METHOD: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The overall response rate was 73.1%(69.4% among men, and 77.6% among women). Women were asked the number of times they had experienced a live birth, a still birth, a miscarriage and a termination of pregnancy. RESULTS: Of the women surveyed, 15.5% reported having experienced difficulty in becoming pregnant and 76.1% had been pregnant at least once. Nearly all the women who had been pregnant reported experiencing a live birth. Substantial minorities of women reported having experienced a miscarriage (33.4%) or a termination of pregnancy (22.6%). The percentage of women who reported becoming pregnant the first time as a teenager declined from 22.8% among women aged 50-59 to 16.9% among women aged 20-29. Of those who had had vaginal intercourse, 19.2% had used emergency contraception, 53.3% of them only once. CONCLUSION: There was clear evidence of substantial changes in the fertility of Australian women over the past 40 years.

OBJECTIVE: To provide reliable estimates of the prevalence, correlates and consequences of sexual coercion among a representative sample of Australian adults. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The response rate was 73.1%(69.4% men, 77.6% women). RESULTS: Overall, 4.8% of men and 21.1% of women had experienced sexual coercion, i.e. being forced or frightened into unwanted sexual activity, and 2.8% of men and 10.3% of women had been coerced when aged 16 or younger. Although women were significantly more likely than men to have been sexually coerced, correlates of sexual coercion were similar for men and women and were not limited to effects on sexual behaviour. People who had been coerced reported greater psychosocial distress, were more likely to smoke, were more anxious about sex, and more likely to have acquired a sexually transmitted infection. Few people had talked to others about their experiences of sexual coercion and fewer had talked to a professional. CONCLUSION: Sexual coercion is an unacceptably common experience. Sexual coercion has detrimental effects on various aspects of people's lives. It most commonly occurs at the ages at which people become sexually active and women are more likely than men to be sexually coerced. IMPLICATIONS: There may be need for more readily accessible services that are better able to minimise the detrimental effects of sexual coercion. This is in addition to a more general need to reduce the incidence of sexual coercion.

OBJECTIVE: To describe the characteristics of Australian adults' experience of commercial sex. METHOD: Telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years (response rate 73.1%; 69.4% men, 77.6% women). Respondents were asked about their experiences both as clients and as sex workers. Socio-demographic and health factors associated with experience of commercial sex were explored for men. RESULTS: Almost one in six Australian men (15.6%) have ever paid for sex; 1.9% had done so in the past year. Of men who had ever paid for sex, 97% had paid for sex with a woman and 3% for sex with a man. Very few women (0.1%) had ever paid for sex. Twice as many men (0.9%) as women (0.5%) had ever been paid for sex; two-thirds of these men (0.6%) were paid by other men. Condom use during vaginal sex was highest in parlours and brothels and with escorts, and lowest for street sex work. Two-thirds of women who had ever been paid for sex had done so only overseas. One in 10 men who had paid for sex had only done so overseas. Men who had paid for sex were more likely than other men to smoke, to drink more alcohol, to have had a sexually transmitted infection or been tested for HIV, to have more sexual partners, to have first had vaginal intercourse before 16, and to have had heterosexual anal intercourse. CONCLUSION: Sex work overseas, where condom use may not be common, represents a potential source of HIV or sexually transmitted infection.