Factors associated with group sex in heterosexual males and females attending a sexual health clinic in Melbourne, Australia: a cross-sectional survey
Heidi Constantinou A B , Christopher K. Fairley
A B , Catriona S. Bradshaw A B C , Edmond P. H. Choi D , Kate Maddaford A , Tiffany R. Phillips A B # and Eric P. F. Chow A B C # *
A Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic. 3053, Australia.
B Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic. 3004, Australia.
C Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic. 3053, Australia.
D School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong.
Handling Editor: Matthew Hogben
Sexual Health 19(1) 39-45 https://doi.org/10.1071/SH21224
Submitted: 11 November 2021 Accepted: 2 January 2022 Published: 16 March 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: There have been limited studies of group sex among heterosexual individuals. This study aimed to explore the factors associated with group sex among heterosexual males and females to improve risk assessment guidelines and inform sexually transmitted infection (STI) screening requirements.
Methods: A cross-sectional survey was conducted among heterosexual males and females aged ≥16 years attending the Melbourne Sexual Health Centre between March and April 2019. The survey asked about group sex participation, methods used to meet sexual partners, number of casual and/or regular partners, and injection drug use (IDU) in the previous 3 months. HIV and STI (chlamydia, gonorrhoea, syphilis) diagnoses were extracted. A multivariable logistic regression was conducted to identify the factors associated with group sex participation.
Results: A total of 698 participants (325 males, 373 females) were included and 4.7% (33/698) had participated in group sex in the previous 3 months. The proportion who participated in group sex increased with age (2.1% in 16–24 years, 5.5% in 25–34 years, 7.8% in ≥35 years, ptrend = 0.010). Meeting partners at sex venues (e.g. brothels) was associated with the highest odds of participating in group sex (aOR = 5.74, 95% CI: 1.20–27.44), followed by dating apps (aOR = 2.99, 95% CI: 1.36–6.58), friends/family (aOR = 2.99, 95% CI: 1.34–6.69) and social venues (e.g. bar) (aOR = 2.73, 95% CI: 1.18–6.30). Group sex was strongly associated with STI positivity (aOR = 6.24, 95% CI: 2.41–16.13). There was no association between group sex and sex, casual and/or regular partners, HIV positivity or IDU.
Conclusion: Heterosexual individuals participating in group sex had a six-fold risk of testing positive for STIs. Including group sex in a sexual history is useful to determine STI risk and inform testing practices. Safe sex messages on group sex that are delivered through multiple methods (e.g. at sex venues, social venues and dating apps simultaneously) would be beneficial.
Keywords: dating apps, group sex, heterosexuals, safe sex, screening, sex party, sex venues, sexual behaviour, sexual practices, sexual risk, sexually transmitted diseases, sexually transmitted infections, threesome.
References
[1] Jasek E, Chow EP, Ong JJ, Bradshaw CS, Chen MY, Hocking JS, et al. Sexually transmitted infections in Melbourne, Australia from 1918 to 2016: nearly a century of data. Commun Dis Intell Q Rep 2017; 41 E212–22.| 29720070PubMed |
[2] Grov C, Rendina HJ, Breslow AS, Ventuneac A, Adelson S, Parsons JT. Characteristics of men who have sex with men (MSM) who attend sex parties: results from a national online sample in the USA. Sex Transm Inf 2014; 90 26–32.
| Characteristics of men who have sex with men (MSM) who attend sex parties: results from a national online sample in the USA.Crossref | GoogleScholarGoogle Scholar |
[3] Meunier É, Siegel K. Sex club/party attendance and STI among men who have sex with men: results from an online survey in New York City. Sex Transm Inf 2019; 95 584–7.
| Sex club/party attendance and STI among men who have sex with men: results from an online survey in New York City.Crossref | GoogleScholarGoogle Scholar |
[4] Phillips TR, Fairley CK, Bradshaw CS, Hocking JS, Choi EPH, Ong JJ, et al. Group sex among men who have sex with men in the era of PrEP: a cross-sectional study. J Acquir Immune Defic Syndr 2021; 86 e23–7.
| Group sex among men who have sex with men in the era of PrEP: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar | 33093332PubMed |
[5] van den Boom W, Davidovich U, Heuker J, Lambers F, Prins M, Sandfort T, et al. Is group sex a higher-risk setting for HIV and other sexually transmitted infections compared with dyadic sex among men who have sex with men? Sex Transm Dis 2016; 43 99–104.
| Is group sex a higher-risk setting for HIV and other sexually transmitted infections compared with dyadic sex among men who have sex with men?Crossref | GoogleScholarGoogle Scholar | 26766526PubMed |
[6] Goedel WC, Duncan DT. Correlates of engagement in group sex events among men who have sex with men in London who use geosocial-networking smartphone applications. Int J STD AIDS 2018; 29 244–50.
| Correlates of engagement in group sex events among men who have sex with men in London who use geosocial-networking smartphone applications.Crossref | GoogleScholarGoogle Scholar | 28764613PubMed |
[7] Scheidell JD, Friedman SR, Golin C, Wohl DA, Khan MR. Group sex event participation: a link to STI risk among African-American heterosexual men incarcerated in North Carolina. Sex Transm Infect 2017; 93 144
| Group sex event participation: a link to STI risk among African-American heterosexual men incarcerated in North Carolina.Crossref | GoogleScholarGoogle Scholar | 28213578PubMed |
[8] Buttram ME, Kurtz SP. Frequency of group sex participation and risk for HIV/STI among young adult nightclub scene participants. Int J Sex Health 2018; 30 12–19.
| Frequency of group sex participation and risk for HIV/STI among young adult nightclub scene participants.Crossref | GoogleScholarGoogle Scholar | 30774740PubMed |
[9] Friedman SR, Mateu-Gelabert P, Sandoval M. Group sex events amongst non-gay drug users: an understudied risk environment. Int J Drug Policy 2011; 22 1–8.
| Group sex events amongst non-gay drug users: an understudied risk environment.Crossref | GoogleScholarGoogle Scholar | 20800465PubMed |
[10] Buttram ME, Kurtz SP. Characteristics associated with group sex participation among men and women in the club drug scene. Sex Health 2015; 12 560–2.
| Characteristics associated with group sex participation among men and women in the club drug scene.Crossref | GoogleScholarGoogle Scholar | 26342286PubMed |
[11] Scoats R, Anderson E. ‘My partner was just all over her’: jealousy, communication and rules in mixed-sex threesomes. Cult Health Sex 2019; 21 134–46.
| ‘My partner was just all over her’: jealousy, communication and rules in mixed-sex threesomes.Crossref | GoogleScholarGoogle Scholar | 30764748PubMed |
[12] Thompson AE, Cipriano AE, Kirkeby KM, Wilder D, Lehmiller JJ. Exploring variations in North American adults’ attitudes, interest, experience, and outcomes related to mixed-gender threesomes: a replication and extension. Arch Sex Behav 2021; 50 1433–48.
| Exploring variations in North American adults’ attitudes, interest, experience, and outcomes related to mixed-gender threesomes: a replication and extension.Crossref | GoogleScholarGoogle Scholar | 33175272PubMed |
[13] Constantinou H, Fairley CK, Hocking JS, Bradshaw CS, Choi EPH, Maddaford K, et al. Associations between methods of meeting sexual partners and sexual practices among heterosexuals: cross-sectional study in Melbourne, Australia. JMIR Form Res 2021; 5 e26202
| Associations between methods of meeting sexual partners and sexual practices among heterosexuals: cross-sectional study in Melbourne, Australia.Crossref | GoogleScholarGoogle Scholar | 34283024PubMed |
[14] Phillips TR, Constantinou H, Fairley CK, Bradshaw CS, Maddaford K, Chen MY, et al. Oral, vaginal and anal sexual practices among heterosexual males and females attending a sexual health clinic: a cross-sectional survey in Melbourne, Australia. Int J Environ Res Public Health 2021; 18 12668
| Oral, vaginal and anal sexual practices among heterosexual males and females attending a sexual health clinic: a cross-sectional survey in Melbourne, Australia.Crossref | GoogleScholarGoogle Scholar | 34886391PubMed |
[15] Turek EM, Fairley CK, Tabesh M, Phillips TR, Chow EPF. Group sex events among female sex workers in Melbourne, Australia. Sex Health 2020; 17 534–7.
| Group sex events among female sex workers in Melbourne, Australia.Crossref | GoogleScholarGoogle Scholar | 33172563PubMed |
[16] Chow EPF, Hocking JS, Bradshaw CS, Phillips TR, Tabesh M, Donovan B, et al. Paying for sex among males and females: a cross-sectional survey in Melbourne, Australia. Sex Transm Dis 2021; 48 195–9.
| Paying for sex among males and females: a cross-sectional survey in Melbourne, Australia.Crossref | GoogleScholarGoogle Scholar | 33555761PubMed |
[17] Mark KP, Lasslo JA. Maintaining sexual desire in long-term relationships: a systematic review and conceptual model. J Sex Res 2018; 55 563–81.
| Maintaining sexual desire in long-term relationships: a systematic review and conceptual model.Crossref | GoogleScholarGoogle Scholar | 29521522PubMed |
[18] Conley TD, Matsick JL, Moors AC, Ziegler A, Rubin JD. Re-examining the effectiveness of monogamy as an STI-preventive strategy. Prev Med 2015; 78 23–8.
| Re-examining the effectiveness of monogamy as an STI-preventive strategy.Crossref | GoogleScholarGoogle Scholar | 26116890PubMed |
[19] Malta S, Hocking J, Lyne J, McGavin D, Hunter J, Bickerstaffe A, et al. Do you talk to your older patients about sexual health? Health practitioners’ knowledge of, and attitudes towards, management of sexual health among older Australians. Aust J Gen Pract 2018; 47 807–11.
| Do you talk to your older patients about sexual health? Health practitioners’ knowledge of, and attitudes towards, management of sexual health among older Australians.Crossref | GoogleScholarGoogle Scholar | 31207681PubMed |
[20] Gott M, Hinchliff S, Galena E. General practitioner attitudes to discussing sexual health issues with older people. Soc Sci Med 2004; 58 2093–103.
| General practitioner attitudes to discussing sexual health issues with older people.Crossref | GoogleScholarGoogle Scholar | 15047069PubMed |
[21] Freedman E, Britt H, Harrison CM, Mindel A. Sexual health problems managed in Australian general practice: a national, cross sectional survey. Sex Transm Infect 2006; 82 61–6.
| Sexual health problems managed in Australian general practice: a national, cross sectional survey.Crossref | GoogleScholarGoogle Scholar | 16461607PubMed |
[22] Woodward C, Fischer J, Najman JM, Dunne M. Selling sex in Queensland 2003: a study of prostitution in Queensland. Prostitution Licensing Authority; 2003.
[23] Bellhouse C, Walker S, Fairley CK, Chow EP, Bilardi JE. Getting the terminology right in sexual health research: the importance of accurately classifying fuck buddies among men who have sex with men. Sex Transm Infect 2018; 94 487–9.
| Getting the terminology right in sexual health research: the importance of accurately classifying fuck buddies among men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 28356437PubMed |
