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Sexual Knowledge, Attitudes and Behaviours
National sexual health survey amongst the Maltese population aged 16 to 40

years
2012
Directorate for Health Information and Research

Department of Health
Ministry for Health
www.healthsurveys.gov.mt
Malta
October 2013
Foreword
The Sexual Health Strategy for Malta, published in 2011, lays down the
following conditions for the attainment of good sexual health:
Sexual health requires a positive, respectful approach to

sexuality and relationships and the possibility of having
pleasurable and safe sexual experiences, free of coercion,
discrimination and violence.
This survey carried out by the Directorate for Health Information and
Research marks the first attempt at investigating the empowerment of
the Maltese youth and young adults to engage in healthy sexual
relationships, regardless of their preferences or abilities.
Some interesting insights have come out of the survey. One interesting aspect is the concept of
sexual education as applied in Malta. There seems to be a reluctance of parents to engage in sexual
education – particularly among fathers, possibly because sexual education is thought to concern only
the biological aspects of sexual intercourse. In addition, Maltese teens can clearly identify their
early teens as the point of first exposure to sexual education, suggesting an abrupt introduction at
secondary school level rather than a gradual exposure from a younger age.
One cannot ignore that a third of people engaging in sexual activity for the first time do not use
contraception, this needs highlighting especially in a context where around 41% of 16 to 18 year olds
are already exploring sexual activity. There is also clearly a need for better empowerment of our
young people – making people feel comfortable about engaging in a discussion with their partner on
their mutual wishes to engage in sexual activity.
Another area that warrants attention is the need to have a friendly, confidential and professional
service to help individuals deal with sexual dysfunction and perceptions thereof. A desire for such
services does not come only from the older participants of the survey, as one might expect, but
predominantly from the young upcoming generation.
These are some of the issues identified by this report. A number of them are quite complex and
addressing them is likely to require a multidisciplinary approach. The Ministry for Health will be
looking into these issues and, where required, engaging in a dialogue with other partners and
stakeholders. As stated in the Sexual Health Strategy, attaining such a knowledge base is imperative
for the implementation of the Strategy. This new information will help the Ministry shape its
policies and target its resources at the areas and population groups that are most in need, in order
to preserve efficiency and efficacy, while attaining good sexual health for all.
The Ministry would also like to reiterate its commitment to research and evidenced based policy and
looks forward to further research in the area from the Directorate for Health Information and
Research and from other research groups who would like to engage with the Ministry in the pursuit
of good sexual health for all.
Hon. Dr. Godfrey Farrugia

Minister for Health
3
Sexual Knowledge, Attitudes and Behaviours – National Survey Malta 2012
Preface
The 2012 National Sexual Health Survey is the first attempt at a comprehensive assessment of the
sexual knowledge, attitudes and behaviour of the population aged 16-40 years. The aim of the study
was to collect information on knowledge and attitudes towards sexual behaviour, personal
experiences as well as knowledge about sexual health services and desired services. Apart from this,
a component of the questionnaire for the 16 to 18 year olds explored current sex education. In total
1117 respondents took part in this survey which was conducted through a self-completed
questionnaire in spring 2012.
Formal as well as informal sex education is an essential component in the development of sexual
knowledge. Sex education in Malta seems to start in the early teens. Mothers and teachers are the
most important source of sexual information especially in relation to topics on puberty and sexual
reproduction. Teenagers report that they would like more involvement from their parents in
relation to sex education most notably in topics not related to the biological aspect of reproduction.
Knowledge and attitudes towards sexual behaviour vary by age, gender and education. In general
women have more knowledge about the misconceptions surrounding pregnancy and the
contraceptive pill while men are more knowledgeable about condoms. Women are also less inclined
towards having one night stands. Amongst the youngest age groups there were more
misconceptions about contraception and pregnancy but more knowledge about sexually acquired
infections (SAI). As expected, better knowledge of sexual health was noted in the higher education
groups.
Approximately 78% of respondents across all age groups, report that they are sexually active.
Amongst those 16 to 18, 41% report having had sexual intercourse. When asked about their first
sexual intercourse, 41% of the sexually active report that they knew their partner a few months
before having sexual intercourse while 6% say they had just met. Nearly half of those who are
sexually active say they had sex the first time because they felt in love with their partner.
As many as 30% of respondents say they used no contraception during their first sexual intercourse.
No contraception use was highest amongst those aged 16 to 18. Approximately 73% of the sexually
active population report having one partner in the last 6 months. Multiple partners are more
common amongst the younger respondents and men. In total 32% of those who report having more
than one partner in the last 6 months used a condom.
In total, 6.6% of respondents report that they were diagnosed with an SAI by a medical professional.
A little over 60% of respondents were aware that a free service for the testing of SAIs is available in
Malta. When asked, respondents rate confidentiality, testing for SAIs, a friendly atmosphere, advice
about performing sexually and pregnancy testing as the most desirable features of a free sexual
health service.
Dr. Neville Calleja Dr. Natasha Azzopardi Muscat

Director Chief Medical Officer
Directorate for Health Information and Research Department of Health
5
Acknowledgements
The Directorate would like to take the opportunity to thank all the respondents who participated in
this survey as well as all the interviewers for their contribution towards the success of this survey.
The Directorate would also like to thank the Chief Medical Officer Dr. Natasha Azzopardi Muscat and
the Ministry for Health for their continuous support along the duration of this project. We also
would like to thank our colleagues at the Health Promotion and Disease Prevention Directorate for
their valuable contribution by creating the “useful contact number” cards and supplying us with the
health promotion material which was given to each respondent. Furthermore we would like to thank
Dr. Roderick Bugeja for his expert consultation in the development of the survey tool.
Finally, we thank all the staff at the Directorate as well as the public health trainees who contributed
along the entire duration of the project, sometimes over and above their regular duties, to ensure
that the project was a success. Without the tireless dedication of a small but determined team, this
project and the results achieved would never have materialized.
This report has been compiled by Ms. Dorothy Gauci.
6
Contents
Foreword ..................................................................................................................................... 3
Preface ........................................................................................................................................ 5
Acknowledgements...................................................................................................................... 6
1. Introduction ....................................................................................................................... 10
Background ....................................................................................................................................... 10
Sexual health promotion and sexual health services in Malta – Setting the scene ......................... 11
Aims and objectives of this study ..................................................................................................... 12
2. Methodology ...................................................................................................................... 13
Study design...................................................................................................................................... 13
Sampling ........................................................................................................................................... 13
Questionnaire ................................................................................................................................... 14
Ethical considerations ....................................................................................................................... 15
Fieldwork .......................................................................................................................................... 15
3. Data analysis ...................................................................................................................... 16
Method ............................................................................................................................................. 16
Description of the study population ................................................................................................. 16
RESULTS .................................................................................................................................... 17
4. Sexual education amongst 16 to 18 year olds ...................................................................... 18

Learning about puberty .................................................................................................................... 18
Learning about the reproductive systems of men and women ....................................................... 19
Learning about other aspects of sexual behaviour – sexual orientation, practices and pleasure ... 19
Key findings....................................................................................................................................... 21
5. Knowledge about sexual health and attitudes towards sexual behaviour ............................. 22
Knowledge ........................................................................................................................................ 22
Attitudes ........................................................................................................................................... 24
Key findings....................................................................................................................................... 26
6. Personal experiences .......................................................................................................... 27
First experience of sexual intercourse.............................................................................................. 27
Recent experience of sexual intercourse ......................................................................................... 29
Risky sexual behaviour...................................................................................................................... 30
Sexual dysfunction ............................................................................................................................ 30
Key findings....................................................................................................................................... 31
7. Sexual health services ......................................................................................................... 33
Knowledge and prevalence of sexually acquired infections............................................................. 33
Knowledge about present sexual health services ............................................................................ 33
Desired qualities of sexual health services ....................................................................................... 34
Key findings....................................................................................................................................... 35
ANNEX OF TABLES AND FIGURES ................................................................................................ 36
7
List of Tables
Table 1: Who teenagers report taught them about certain aspects of sexuality and sexual behaviour
.............................................................................................................................................................. 37
Table 2: Who teenagers report they preferred taught them about certain aspects of sexuality and
sexual behaviour ................................................................................................................................... 38
Table 3: Where teenagers report they learnt about certain aspects of sexuality and sexual behaviour
.............................................................................................................................................................. 39
Table 4: Where teenagers wished they learnt about certain aspects of sexuality and sexual behaviour
.............................................................................................................................................................. 39
Table 5: Which resources teenagers report were used when they learnt about certain aspects of
sexuality and sexual behaviour ............................................................................................................. 40
Table 6: Which resources teenagers report they preferred were used when learnt about certain
aspects of sexuality and sexual behaviour............................................................................................ 41
Table 7: Respondents knowledge about certain aspects of sexual health and reproduction (a)........ 43
Table 8: Respondents knowledge about certain aspects of sexual health and reproduction (b) ........ 44
Table 9: Respondents attitudes towards certain aspects of sexual behaviour and sexuality (a) ........ 45
Table 10: Respondents attitudes towards certain aspects of sexual behaviour and sexuality (b)....... 46
Table 11: Respondents relationship with partner before first sexual intercourse .............................. 49
Table 12: Main reasons for first sexual intercourse............................................................................. 49
Table 13: Use of contraception during first sexual intercourse........................................................... 50
Table 14: Discussing contraception with present sexual partner ........................................................ 50
Table 15: Number of sexual partners in last 6 months, last year and lifetime .................................... 53
Table 16: Influence of alcohol and drug consumption on sexual behaviour ....................................... 54
Table 17: Frequency of sexual dysfunctions and treatment................................................................ 54
Table 18: Knowledge of SAIs, proportion having had an SAI and proportion who know what a GU
clinic is ................................................................................................................................................... 55
Table 19: Knowledge of free SAI testing services in Malta and where they are located..................... 55
Table 20: Knowledge of signs and symptoms of SAIs .......................................................................... 56
Table 21: Desired features of sexual health services (a) ..................................................................... 58
Table 22: Desired features of sexual health services (b) ..................................................................... 58
Table 23: Desired features of sexual health services (c) ...................................................................... 59
Table 24: Desired features of sexual health services (d) ..................................................................... 60
Table 25: Desired features of sexual health services (e) ..................................................................... 61
8
List of Figures
Figure 1: Respondents' knowledge about certain aspects of sexual health and reproduction............ 42
Figure 2: Respondents' attitudes towards certain aspects of sexual behaviour and sexuality ............ 42
Figure 3: Proportion of respondents having ever had sexual intercourse and proportion having
engaged in various sexual behaviours, by age...................................................................................... 47
Figure 4: Proportion of respondents having ever had sexual intercourse and proportion having
engaged in various sexual behaviours, by gender ................................................................................ 47
Figure 5: Attitude towards and feelings about first sexual intercourse before and after first
intercourse, by age ............................................................................................................................... 48
Figure 6: Attitude towards and feelings about first sexual intercourse before and after first
intercourse, by gender .......................................................................................................................... 48
Figure 7: Use of contraception during most recent sexual intercourse amongst respondents with 2 or
more partners in the last 6 months, by age.......................................................................................... 51
Figure 8: Use of contraception during most recent sexual intercourse amongst respondents with 2 or
more partners in the last 6 months, by gender .................................................................................... 51
Figure 9: Frequency of condom use amongst respondents with 2 or more partners in the last 6
months, by age...................................................................................................................................... 52
Figure 10: Frequency of condom use amongst respondents with 2 or more partners in the last 6
months, by gender ................................................................................................................................ 52
Figure 11: Desired features of sexual health services amongst total ................................................... 57
9
1. Introduction
Background
Sexual health is an integral element of the health of all human beings. On the 26th of November
2010, the National Sexual Health Policy for the Maltese Islands was launched1. The working
definition of sexual health, used in this policy is that sexual health is a state of physical, emotional,
mental and social well-being in relation to sexuality; it is not merely the absence of disease,
dysfunction or infirmity. It requires a positive, respectful approach to sexuality and relationships and
the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination
and violence. For sexual health to be attained, the sexual rights of all persons must be respected,
protected and fulfilled.
The major indicators of sexual health identified can be classified as those related to:
∗ Social and behavioural factors

∗ Monitoring and surveillance policies
∗ Legislation
∗ Medical and health services
∗ Health education
∗ Evaluation and quality assurance policies
The aim of the National Sexual Health Policy was to inform and direct the development of a
comprehensive evidence based national sexual health strategy for the attainment of maximum
health and wellbeing of all the population.
On the 7th of November 2011, a year after the release of the National Sexual Health Policy, the
National Sexual Health Strategy was launched2. The strategy was built in line with the definitions,
principles and objectives outlined in the policy. Developed through workshops and feedback from
experts consulted, the strategy aims to address the multi-faceted definition of sexual health as
1
Ministry for Health, the Elderly and Community Care, 2010. The national sexual health policy for the Maltese
Islands, MHEC Malta. Available online: https://ehealth.gov.mt/download.aspx?id=4368
2
Ministry for Health, the Elderly and Community Care, 2011. National sexual health strategy, MHEC Malta.
Available online: https://ehealth.gov.mt/download.aspx?id=6452
10
adopted by the policy. The participation and contribution of all entities, sectors, groups and
representatives of the entire population helped towards the development of the strategy.
The target areas that the strategy aims to address in the coming years are the following:
∗ Sexual health promotion and education

∗ Sexual health cares services
∗ Dignity, rights and responsibilities
∗ Research and surveillance
Both the policy and the strategy reiterate the need for comprehensive evidence about the local
situation in relation to sexual health through research. In light of this, this survey was designed to
assess the sexual health knowledge, attitudes and behaviours of the Maltese population. This
evidence specifically relating to Maltese population will provide policy makers and service providers
with important information on which to assess, adapt and develop targeted services and campaigns.
Sexual health promotion and sexual health services in Malta – Setting the scene
Health Promotion initiatives by the Health Promotion and Disease Prevention Directorate include
raising awareness on contraception, Sexually Acquired Infections and personal skills such as sexual
assertiveness and negotiation skills. The Directorate works closely with the Education Department
including the PSD Educational officers and PSD teachers. The Directorate also offers lectures to
University students as part of their yearly curriculum. The sexual health promotion work conducted
by the Directorate targets all age groups as well as including people with intellectual and physical
disabilities.
Health Promotion initiatives are carried out in various settings including schools, the community and
workplaces. The work is done in partnership with other organizations such as MMSA (Malta Medical
Students Association), Agenzija Zaghzagh, migrant workers, MGRM (Malta Gay Rights Movement),
people who work with prisoners and ACCESS in order to broaden the educational services to specific
target groups. Health care professionals are updated with the latest information regarding sexual
health. Various mediums are used to deliver the information including radio, television, leaflets,
websites and social media for a wider transmission of the sexual health messages.
11
One of the stakeholders identified in the sexual health strategy is the media. An information media
pack was developed for use by journalists, media production houses, script writers and students in
the field to provide them with the right information and the right vocabulary on the subject. This
media pack was launched by the Minister for Health on the 12th of September 20133.
A National Chlamydia screening research project is being carried out in the community with the help
of General Practitioners acting as sentinel sites so that sexually active men and women from the
ages of 18-35 years are offered testing. Partner notification is carried out after positive results. Such
research is carried out to measure the true incidence of the infection in the community, identify
problems and give the necessary attention to prevent the disease.
Specific campaigns are also organised for specific international days such as World Hepatitis Day and
World Aids Day. All written material is specifically designed accordingly in the form of leaflets and
posters and are distributed amongst all governmental entities, local councils, Drug Rehabilitation
organizations such as Detox and Sedqa and all health centres.
A major milestone in the implementation of the sexual health strategy is the setting up of a National
Sexual Health Website equipped with all the information needed regarding the subject. This
interactive website includes a forum which aims to stimulate discussions, and to deal with specific
queries.
Apart from the work conducted by the Directorate, a free Genitourinary Clinic (GU) operates at
Mater Dei Hospital offering diagnosis and treatment of Sexually Acquired Infections (SAIs),
counselling and testing for HIV as well as treatment for other genital conditions not necessarily
acquired sexually. The clinic works under a policy of absolute confidentially.
Aims and objectives of this study
The main aim of this survey was to determine the sexual knowledge, attitudes and practices of the
resident Maltese population aged 16 to 40 years. The questionnaire collected information on the
following topics:
3
Ministry for Health, 2013. Sexual health – Media resource pack. MFH Malta. Available online:
https://ehealth.gov.mt/download.aspx?id=9435
12
∗ Sex Education – experiences and desired teaching methods amongst 16 – 18 year olds in the
study population.
∗ Knowledge and attitudes towards sexual behaviour and sexual health amongst the entire study
population.
∗ Personal experiences – sexual behaviour, condom use, first sexual experience and risky
behaviours.
∗ Sexual health services – knowledge about sexually acquired infections, knowledge about present
sexual health services available in Malta and gaining information on the services the population
would like to see made available in relation to sexual health.
∗ Demographics – age, gender, education etc.
This information will not only give a snapshot of the sexual behaviour of the population but will help
public health policy address the needs of the population in relation to sexual health services and sex
education.
2. Methodology
Study design
The survey employed a cross sectional population based study design using a paper based
questionnaire. Due to the sensitive nature of the subject, a self-reported questionnaire was used
and it took 20 minutes on average for each respondent to complete.
Sampling
A quota sampling technique was used. A quota sampling technique was preferred over a random
sampling technique due to the sensitive nature of the subject and the possibility of increased risk of
non-response in the former technique. Generally 25% - 35% of individuals refuse to participate in
telephone or face-to-face interviews that investigate attitudes and sexual lifestyles. This is higher for
postal surveys with a non-return rate of up to 40%4. Since quota sampling does not sample specific
respondents to answer the questionnaire, the issue of non-response is reduced as interviewers
continue to seek out respondents who fit specific demographic criteria even after refusals. Usual
4
Kevin A Fenton, Fenton, KA., Johnson, AM., McManus, S. & Erens, B. Measuring sexual behaviour:
methodological challenges in survey research. Sex Transm Infect 2001;77:2 84-92
13
random sampling methods limit one from doing this as specific participants are sampled and
substitution of respondents is likely to introduce more bias in the survey. In fact, quota sampling is
considered representative in a setting where a normal random sample is likely to end up with low
response, as would be expected in sensitive surveys5.
To ensure that the study population was representative of the resident Maltese population aged 16
to 40, quotas were created based on specific demographic features. The study population of 1,200
respondents was split into three age groups – 16 to 18, 19 to 25 and 26 to 40. Representativeness of
the Maltese population was preserved by specifying the number of respondents required in each
age group by gender, educational level and region of residence based on existing national statistics.
Since the type of sex education of interest is the current one, this is studied only within the 16-18
age group, therefore oversampling of this population (16 to 18) was conducted to ensure maximum
participation.
To further ensure that the study was representative of the study population and to adjust for the
over sampling of the younger age group, during analysis the data was weighted against a larger
national survey by the demographic criteria selected. This will be discussed later on in this section.
Questionnaire
The questionnaire for this survey was designed following consultation with experts in the field to
asses the specific needs for a survey on this topic in Malta. The questionnaire was adapted mainly
from two sources – a WHO instrument developed as a template for researchers to develop a survey
on sexual and reproductive behaviour amongst young people 6 and a national longitudinal survey on
sexual health conducted in Northern Ireland7. These two tools were used as a starting point and the
questionnaire was adapted and developed further to cater for the Maltese context. The
questionnaire was reviewed by various experts in the field of sexual health and education and their
feedback was incorporated in the final version. Piloting and pre-testing of the questionnaire was
5
Cumming RG. 1990. Is probability sampling always better? A comparison of results from a quota and a
probability sample survey. Community Health Studies 14(2):132-7
6
Cleland, J. Illustrative questionnaire for interview-surveys with young people. Sexual and reproductive health
of adolescents. WHO. Available online:
http://www.who.int/reproductivehealth/topics/adolescence/questionnaire.pdf
7
“Towards Better Sexual Health: A survey of sexual attitudes and lifestyles of young people in Northern Ireland,
2000-2002”, University of Ulster, Northern Ireland. Available online:
http://www.esds.ac.uk/doc/6145/mrdoc/pdf/6145userguide.pdf
14
conducted and the necessary corrections were made. A translation into Maltese was conducted by
qualified translators.
The questionnaire covered the following five sections:
a) Sources of information about sexual and reproductive health (sex education)

b) Knowledge about sexual health and attitudes towards sexual behaviour
c) Personal experiences
d) Sexual health services
e) Demographics
For the 16 to 18 year old age group, all five sections were included in the questionnaire while for
those aged 19 to 40 the section on sex education (a) was excluded. It was decided that questions
about how youth acquire their information about sexual and reproductive health should only be
addressed to the youngest age group, since this reflects the present experience of sex education in
Malta.
Ethical considerations
Verbal consent was obtained by the interviewers prior to administering the questionnaire to
participants. The aim of the study was explained to participants and emphasis was made on the fact
that participation was voluntary and the information collected was anonymous and confidential. No
personal identifiers were collected in the questionnaire. The participants were asked to fill in the
questionnaire on their own and they were subsequently sealed by the respondent in an unmarked
envelope. Ethical approval to conduct this survey among 16-18 year olds without seeking parental
consent was obtained through the Health Ethics Committee.
Fieldwork
The fieldwork for this study was conducted in spring 2012 across all regions in Malta and Gozo.
Interviewers were recruited by the Directorate amongst public officers and public sector employees
within the Ministry. Following selection, the interviewers attended training sessions organised by
the project team before survey fieldwork began. The fieldwork was seen as a good opportunity to
promote positive sexual health behaviours and educate the population. In conjunction with the
Health Promotion and Disease Prevention Directorate health promotion material was uploaded onto
15
pen drives which were given to each participant upon completion of the survey. Also contact cards
for the services at the Health Promotion Directorate as well as the GU clinic were given to the
participants should they have any queries upon completion of the survey.
3. Data analysis
Method
To further ensure that the analysis resulting from this study is representative of the total Maltese
population the data was weighted against a larger national health survey, the European Health
Interview Survey (EHIS) conducted in 2008 which had 3,680 participants. Also since oversampling
was conducted for the 16 to 18 year old age group, weighting was required to ensure that analysis
covering the total population was not over representing this age group. The weighted population is
representative of the current age distribution for this age group in the Maltese population.
Analysis of the data was conducted by age, gender and educational level separately for each
category. No multivariate analysis has been carried out.
Description of the study population
In total 1173 respondents completed the questionnaire. Following data cleaning 56 questionnaires
were excluded from the analysis due to the fact that information was missing for age, education or
region and therefore a weight could not be calculated. In total 1117 respondents were considered
in this study though 5 respondents had information for gender missing. In total there were 539
males and 573 females considered in the analysis. The age breakdown of the respondents; before
weighting was 329 16 to 18 year olds, 554 19 to 29 year olds and 234 30 to 40 year olds.
16
RESULTS
4. Sexual education amongst 16 to 18 year olds
Learning about puberty
The mean reported age at which teenagers learned about puberty was 12. The mean age does not
vary by gender. Overall the majority of the teenagers reported having learnt about puberty mainly
from their teacher (45%) followed by their mother (33.5%); a further 12.3% report learning about
puberty from their friends. Only 2.7% said they learnt about puberty from their father.
When looking at gender differences, girls reported learning about puberty more from their mothers
when compared to boys (44.7% compared to 22.4%) while boys reported learning about puberty
more from their teachers when compared to girls (52.4% compared to 37.6%). Less than 1% of girls
report learning about puberty from their father compared to 5% amongst boys. Compared to girls,
boys also report learning from friends more than girls.
As expected the most common place where teenagers learnt about puberty is school with 69%
reporting they learnt from school and 24% reporting they learnt from home. Girls reported learning
more from home when compared to boys while boys reported learning more from school. The
most common resources used when learning about puberty were books and magazines at 24%
followed by the internet at 19%. A further 17% report having learnt through talks/seminars. When
comparing by gender, boys report the use of internet as a source of information on puberty more
than girls.
When asked who they preferred had taught them about puberty, the largest proportion said they
would have preferred their mother to teach them at 37%, which is 4% more than the figure of those
who report their mother having taught them about puberty. The second largest proportion (32.8%)
reported they preferred to have learnt from their teacher about puberty which is less than the
proportion who actually reported they were taught by their teacher. Though in smaller proportions
there were increases in those who preferred a youth worker (4%) and counsellor (2.6%) to teach
them about puberty and a 2% decrease in those reporting they preferred to learn from their friends.
Overall 38.8% preferred to learn from home about puberty, more than the number who do report
learning from home. On the other hand, the proportion preferring to learn from school was less
than the proportion reporting that they did learn from school. In general the preferred resources
are similar when compared to the actual resources with books and the internet remaining the most
18
popular preferred resource and slight increases in films/videos (4% increase) and talks/seminars (2%
increase).
Learning about the reproductive systems of men and women
The mean reported age at which teenagers learnt about reproductive systems of men and women
was 12. The mean age does not vary by gender. The largest majority of the teenagers (65%) report
that they learned about reproduction from their teacher with a further 16% learning about
reproduction from their mother. The father was reported to be the main source of information for
3.8% of respondents while 8.3% learnt from friends. In both genders the teacher is the most
common source of information about reproduction followed by the mother. Amongst girls the
proportion that report they learnt from their mother is slightly higher than that for boys while
amongst boys the proportion who report learning from their father is slightly higher than that for
girls. Overall 83% say they learnt about reproduction from school with only 12% reporting they
learnt from home. Books and magazines were the most common resource used at 28.8% followed
by talks/seminars (19%) and the internet (14%). A larger proportion of girls report making use of
talks/seminars (23%) when compared to boys; while a larger proportion of boys report the use of
books/magazines and the internet.
In terms of the preferred source of information about reproduction versus the actual source, there
seems to be a preference for a move away from the teacher to a home environment, particularly the
increased involvement of the mother. The proportion indicating their teacher as the preferred
source (44%) was considerably less than the proportion indicating their teacher as their actual
source (65%). This was mirrored by a higher proportion indicating their mother as the preferred
source (24%) than those who actually learnt about reproduction from their mother (16%). When
asked about the best location to learn about reproduction, a similar shift was noted away from a
school environment (-21%) to a home environment (+12%). The most popular preferred resource
remains books and magazines followed equally by the internet, videos/films and talks/seminars.
Learning about other aspects of sexual behaviour – sexual orientation, practices and
pleasure
The mean reported age at which teenagers learnt about other aspects of sexual behaviour (sexual
orientation, practices and pleasure) was 13 with a minimum age of 8 and maximum age of 19.
Similar with other topics, there were no gender differences. Unlike with puberty and reproduction,
19
the majority of teenagers report that the person who taught them about other aspects of sexual
behaviour, mainly sexual orientation, practices and pleasure was their friend (38%). The second
largest group report learning from their teacher (29.8%). Only 10% report learning about other
aspects of sexual behaviour from their mother while 4% say they learnt from their brother/sister. Of
the three topics, this had the greatest proportion reporting that no one taught them about these
aspects of sexual behaviour (8%). The proportion learning from friends does not differ by gender.
The greatest differences by gender are in the proportion learning from their teachers with 32%
amongst boys and 28% amongst girls and the proportion reporting that no one taught them with 10%
amongst girls and 6% amongst boys.
Over half of students report learning at school with a further 20% reporting they learnt from places
of entertainment. Only 11% said they learnt from home while 7% report they learnt from a youth
centre. In both genders the school setting was equally the most common place to learn about other
aspects of sexual behaviour. Amongst girls the home setting was slightly more common (12%
compared to 10%) while amongst boys places of entertainment were the more common source (22%
compared to 17%). The internet was the most common resource used by teenagers at 22% followed
by books/magazines (18%). Talks/seminars remain a popular resource at 15%.
When asked who they prefer taught them about other aspects of sexual behaviour, 27% said they
preferred their teacher while 22% still said they preferred their friend. A further 17% said they
wanted to be taught by their mother while 4% wanted to be taught by their father. 8% preferred to
have been taught by a youth worker. When comparing these figures to who actually taught the
respondents about these other aspects of sexual behaviour, it appears that more involvement from
parents would have been preferred, and less from friends. This is especially so for girls with 25%
saying they preferred their mother to teach them. The school remains the preferred place to learn
about sexual behaviour at 51% with 20% preferring the home. The internet remains the most
preferred resource amongst teenagers with 25% reporting they preferred to learn about other
aspects of sexual behaviour from the internet followed by 22% saying they preferred to learn from
talks/seminars.
20
Key findings
• Sex education seems to formally start as children become teenagers at the age of 12 – most
notably when starting secondary school.
• Mothers and teachers remain the two most important sources of sexual information
specifically related to reproductive biology - mainly puberty and sexual reproduction.
• Teenagers seem to desire more involvement from their parents in acquiring their sex
education especially in aspects not related to biology.
• Books, the internet and talks/seminars are the three most useful resources used by
teenagers when acquiring their sex education.
Refer to tables 1 to 6 in the Annex of Tables & Figures for detailed information outlined in this
chapter.
21
5. Knowledge about sexual health and attitudes towards

sexual behaviour
Knowledge
Respondents were presented with 7 statements related to knowledge and attitudes about sexual
behaviour and asked whether they believed they were true or false. In cases where they were not
sure they could choose the option “don’t know”.
Overall 43.7% of respondents correctly identify the statement “You can’t buy condoms if you are less
than 16 years old” as false while 16.8% state that they don’t know. There was no difference by
gender in the response for this statement. The 16-18 year old respondents had the highest
proportion choosing “false” but also the highest choosing “don’t know”. This contrasts with the 30-
40 age group which showed equal proportions choosing “true” and “false” (44.4%) and 11.2%
choosing “don’t know”. The majority of those with the highest level of education believe that
those aged less than 16 can buy condoms (53.6%). This figure decreases to 39.1% for those with a
secondary level of education.
The majority of respondents incorrectly believe that a doctor is legally obliged to tell the parents of a
girl under the age of 16 who requests the contraceptive pill (66.5%) with a further 14.1% stating
“don’t know”. This proportion is highest in the 30-40 age group (69.8%) and lowest in the 16-18 age
group (61.3%). The proportion reporting “don’t know” is highest in the latter group. Women agreed
more with this statement than men (74.9% compared to 58.1%). When looking at education, a
larger proportion in secondary and post-secondary education agreed that a doctor must tell the
parents of a girl under 16 years of age who requests the contraceptive pill (66.9% and 70.5%
respectively) while the largest proportion reporting “don’t know” had a tertiary level of education
(21.1%).
In total, 87.9% of respondents correctly stated that it is against the law to have sex with a girl who is
under 16 years of age. The proportion was highest amongst the 19-29 and 30-40 age group (90%)
with the lowest proportion in the 16-18 age group (76.1%). The 16-18 respondents also had the
highest reporting “don’t know” to this statement at 7.5%. Overall approximately 10% more women
agreed with this statement when compared to men. Those with a higher level of education agreed
22
more with this statement when compared with the lower levels of education while the “don’t know”
option was chosen more by those of a lower level of education.
Most of the respondents (68.4%) were correct in disagreeing with the statement “a girl cannot
become pregnant the first time she has sexual intercourse”. Older respondents were more likely to
identify the correct answer, as were women when compared to men. Another gradient was noted
with level of education, with 88.4% of those with a tertiary education disagreeing as compared to
57.3% in the secondary education group.
Around 60% disagree with the statement that condoms always prevent sexually acquired infections
(SAIs). This proportion is highest in the 16-18 age group (66.3%) and lowest in the 30-40 age group
(51.5%). A higher proportion of men disagree with this statement when compared to women.
Education again plays a role in knowledge on STI prevention with the highest proportion disagreeing
with this statement being those with a tertiary level of education (76.9%) and lowest amongst those
with a secondary level of education (51.7%). This group also has the highest proportion choosing
“don’t know” at 11.5%.
Seventy-eight percent of respondents disagreed with the statement that the contraceptive pill
always prevents pregnancy. This proportion was highest in those aged 30 to 40 (84.2%) and lowest
in those aged 16 to 18 (61%). Also 13.2% of the latter age group chose “don’t know” in response to
this statement. In total, 10% more women disagreed with this statement when compared to men
while double the amount of men chose “don’t know”. The largest proportion disagreeing with this
statement was in the highest education group at 89.4%.
The majority of respondents disagreed that withdrawal always prevents against pregnancy (62.8%)
however 27.5% agreed with this statement. The proportion disagreeing was highest amongst the
30-40 age group (66.1%) and lowest amongst the 16-18 age group (53.8%). The youngest age group
also had the highest reporting “don’t know” (13.9%). There were no large differences between men
in women in the proportion disagreeing with the statement however there was a slightly higher
percentage of women choosing “don’t know”.
23
Attitudes
Respondents were presented with 6 statements related to sexuality and sexual behaviour and asked
to rate their attitude towards these statements on a 5 point Likert scale ranging from “strongly agree”
to “strongly disagree”.
Overall 68.7% of respondents strongly agree or agree that one should be in love before having
sexual intercourse with a little over 10% strongly disagreeing or disagreeing with this statement.
The highest proportion agreeing with this statement was amongst those aged 16 to 18 with a total
of 82.5% strongly agreeing or agreeing. Amongst the other age groups the proportion ranged from
67.9% to 64.9%. Women agreed more with this statement when compared to men. Those with the
lowest level of education had a higher proportion disagreeing or choosing neither when compared
to the other educational groups.
In total, 72% of respondents strongly agree or agree that once you have sex the first time it is harder
to say no the next time. A further 13.4% strongly disagree or disagree. The highest proportion
agreeing with this statement was in the 30-40 age group at 79.3% compared to 65.7% in the 16-18
age group. There were no major differences by gender. Those in the lowest education group had a
higher proportion agreeing with this statement (75.5%) when compared to the highest education
group (68.7%).
The majority of respondents disagreed with the statement “I consider “one night stands” to be ok”
(51.1%) while a total of 25.7% agreed. The highest proportions agreeing with this statement were
amongst those aged 19 to 29 at 28.5% followed by those aged 16 to 18 at 27.4%. A considerably
larger proportion of women disagree with one night stands when compared to men with a
difference of 20%. Those in the lowest education group also had the highest proportion of
respondents agreeing with one night stands (28.8%) when compared to those in the highest
education group (21.6%).
Overall 78.4% of respondents agreed that most of their close friends have had sexual intercourse.
The proportion was 56.3% in the 16-18 age group and went up to 80% and over amongst the older
respondents. More men agreed with this statement when compared to women. Those with a
tertiary level of education also had a higher proportion agreeing with this statement when
compared to the lower educational groups with a difference of about 10%.
24
Amongst those admitting to having more than one partner in the previous year, 54% agree that they
will use a condom the next time they engage in sexual intercourse. A slightly higher proportion of
females (59.2%) agree with this statement when compared to males (50.8%). The highest
reluctance to use a condom during the next intercourse was observed among 19-29 year olds
(37.1%). As for educational level, the highest disagreement was noted in the primary educated
cohort with 41.0% not intending to use a condom on the next occasion they have sexual intercourse,
followed by those with a tertiary education (22.3%). Amongst women with more than 2 sexual
partners in the previous 6 months, 79.3% of them feel confident that they can encourage the
person they have sexual intercourse with to use a condom.
25
Key findings
• Amongst the 16-18 year old age group there are greater misconceptions and uncertainties
about contraception (pill and withdrawal) and pregnancy but greater awareness on
condoms and prevention of SAIs.
• Women in general are more aware of some of the misconceptions surrounding getting
pregnant following first sexual intercourse as well as the use of the pill. Men on the other
hand are slightly more aware of the misconceptions related to the use of condoms and SAI
prevention.
• Educational level seems to be an important factor related to knowledge of sexual health
topics.
• In general, the majority of respondents believe that one should be in love before having
sexual intercourse and that once you have intercourse the first time it is harder to say no the
second time.
• A larger proportion of women disagreed with one night stands when compared to men.
• A little over half of respondents with multiple sexual partners over the previous six months
agree with the statement that they will use a condom the next time they have sexual
intercourse.
Refer to tables 7 to 11 and figures 1 and 2 in the Annex of Tables & Figures for detailed
information outlined in this chapter.
26
6. Personal experiences
When looking at specific sexual practices, 75% of respondents report that they touched genitals,
63.9% report that they had oral sex, 75.5% report they had vaginal sex and 28.5% report that they
had anal sex at least once in their lifetime. The proportions are highest for all sexual practices in the
30-40 age group and amongst men. In total, 77.9% of respondents have had sexual intercourse8 at
least once in their lifetime. The proportion is greatest amongst those aged 30 to 40 with 93.6%
having engaged in sexual intercourse, this is followed by 75.4% amongst 19 to 29 year olds and 40.9%
amongst the 16 to 18 year olds. Eighty-two percent of men report having had sexual intercourse at
least once in their lifetime compared to 73.8% of women.
Respondents were asked about the first time they had sexual intercourse. The mean age at first
sexual intercourse was 18. There is no difference in the mean age at first sexual intercourse amongst
men and women. Women on average report that the partner they had sexual intercourse with the
first time was 3 years older than them. Amongst the sexually active population, age at first
intercourse is lowest amongst the 16 to 18 year olds at 15. This increases to 17 amongst those 19 to
29 and 19 in those 30 to 40 years old. Since the mean age of first sexual intercourse is 18, the data
on sexual experiences in this chapter will not be broken down by educational level. Since this is the
age one typically starts tertiary education, this group would be overrepresented in the analysis by
education.
The remaining results in this chapter refer only to those respondents that report that they have had
sexual intercourse (vaginal and/or anal sex) at least once in their lifetime.
First experience of sexual intercourse
Overall 40.7% of the sexually active respondents report that they had known their partner a few
months before having sexual intercourse the first time. A further 21.1% said they had known them a
few weeks and 16% said that they were in a committed relationship. In total 6.1% of respondents
said that they had just met their partner before they had first sexual intercourse. This is highest
amongst those aged 16 to 18 (10.7%). The proportion reporting that they were in a committed
relationship was highest in the 19-29 age group while in the 30-40 age group the proportion saying
they knew their partner for a few years was approximately double that of the two other age groups.
8
Sexual intercourse refers to penetrative vaginal and/or anal sex.
27
Also 8.1% of the 30-40 age group report that they were married at first sexual intercourse. The
proportion of men reporting that they knew their partner for a few weeks or just met before first
sexual intercourse was triple that of women.
When asked the main reasons for first sexual intercourse 47.5% of respondents report that they
were in love, 44.7% stated that it was a natural follow on in the relationship and 30.4% that they felt
that they were at the right age. The proportions for these 3 reasons were highest in the 30-40 age
group though the most common reason in all age groups is “I was in love”. The reasons “wanted to
lose my virginity”, “friends all doing it” and “curious” were the most popular within the 19-29 age
group. In the 16-18 age group the proportion reporting that they were under the influence of
alcohol/drugs is the highest amongst the three age groups at 6.3%. When comparing men to
women, 20.4% of men report that they wanted to lose their virginity compared to 9.9% of women
while a further 24.8% report that they were curious compared to 18.4% of women. On the other
hand 65.7% of women say that they were in love compared to 31.5% of men and 13.8% of women
say that they gave in to their partners wishes compared to 3.3% of men.
Overall 39.6% state that they expected their first sexual intercourse to happen with 28.5% saying
they “sort of” expected it to happen. The highest proportion reporting they did not expect it to
happen is in the 16-18 age group. Overall 7% more women compared to men report that they did
not expect their first sexual intercourse to happen. In total 11.1% of respondents say they regret
their first sexual intercourse with a further 8.6% saying they sort of regret it. The highest proportion
of regret is amongst those aged 19 to 29. Amongst women the proportion saying they regret their
first sexual intercourse as well as the proportion saying they sort of regret it, is double that of men.
In total, 40.9% of respondents report that they discussed contraception before their first sexual
intercourse. There are no major differences by age. Overall 10% more women say they discussed
contraception. The majority of respondents say they used a condom the first time they had sexual
intercourse (44.4%) however 32.3% say they used withdrawal and 30.1% said they did not use
contraception. The proportion reporting no contraception was highest in the 16 to 18 year old age
group at 36.4%. The use of the withdrawal method amongst the 30-40 age group was nearly double
when compared to the younger age groups Condom use was highest in the 19-29 age group at 48%.
28
Recent experience of sexual intercourse
The majority of respondents report having one sexual partner in the last 6 months (72.8%) and in the
last year (71.2%). When looking at number of lifetime sexual partners the proportions are more
spread out amongst the categories with 35.9% reporting 2 partners, 24.4% reporting 1 partner and
20.7% reporting 6 or more partners. Multiple partners in the last 6 months were more common
amongst the younger age groups with 10.8% reporting 3 to 5 partners in the age group 16 to 18 and
4.2% reporting 6 or more partners in the group 19 to 29. When asking about the number of partners
in the last year, there is a similar pattern with 16.4% of those 16 to 18 reporting 3 or more partners.
Men had a considerably higher proportion reporting multiple partners when compared to women in
all time periods with 29.6% of men reporting 6 or more partners in their lifetime compared to 11.4%
of women.
When considering respondents reporting 2 or more partners in the previous 6 months (multiple
partners), 31.5% said that they used a condom during their last sexual intercourse. A further 15.6%
said they used withdrawal and 8.7% made use of the pill. The majority of respondents with multiple
partners in the previous 6 months report that they used no contraception. The proportion reporting
no contraception use is highest amongst the 30-40 age group and women. Condom use was highest
amongst the 16 to 18 year olds while the oral contraceptive pill was most common amongst the 30-
40 age group.
When asked about frequency of condom use, 5.5% of those with multiple partners in the last 6
months report always making use of condoms and 28.6% say they sometimes use condoms. The
majority report never using condoms at 35.2% with a further 16.5% reporting they rarely use a
condom. Frequency of condom usage was greatest in the younger age groups and men.
Approximately 92% of respondents state that it is easy or quite easy to discuss contraception with
the person they have sexual intercourse with. This proportion is highest amongst the 30-40 age
group at 95%. Overall 25% of those 16 to 18 say it is quite difficult or very difficult to discuss
contraception with their sexual partner. There are no considerable differences by gender.
29
Risky sexual behaviour
Respondents were asked about the influence of alcohol and drugs on their sexual behaviour and
practices. In total, 16.8% of respondents said they have used alcohol/drugs to feel more
comfortable with a sexual partner, 20.6% said they have had unprotected sex because they were
drinking/using drugs, 20% said they have done more sexually then they planned because they were
under the influence of drugs/alcohol and 11.8% said they have done something sexually because of
alcohol/drugs which they regretted afterwards. The patterns vary by age and gender
The younger age groups have a higher proportion reporting that they used alcohol/drugs to feel
more comfortable with a sexual partner. The proportion is also double amongst men when
compared to women. Also the proportion of men reporting that they had unprotected sex under
the influence of alcohol/drugs is double that of women. For this scenario there are no significant
differences between age groups.
A significantly larger proportion of those aged 19 to 29 report that they did more sexually than they
planned because of the influence of alcohol/drugs (27.6%) when compared to the other age groups.
As with the previous two scenarios, men reported more than women that they did more sexually
than planned because of alcohol/drugs. Also in the 19 to 29 age group we find the highest
proportion reporting that they did something sexually that they regretted later because of alcohol
and drugs (19%). Unlike the other scenarios in this case, there is no difference between genders.
Sexual dysfunction
Overall 9.1% of men report having frequent episodes of impotence. This is highest amongst those
aged 16 to 18 at 12.7% and lowest amongst those aged 30 to 40 at 5.3%. Amongst women, 21.7%
report frequently feeling pain or discomfort during sexual intercourse. As with men the proportion
is lowest in the 30-40 age group at 14.9% and higher in the 19-29 and younger age groups. In total,
8.9% of respondents report that they sought professional help to deal with their sexual dysfunction.
This was most common amongst those aged 30 to 40 at 11%. Men were also more likely to seek
help when compared to women. Of those seeking help, 75% addressed their sexual dysfunction
issues towards a medical professional (GP or gynaecologist). The GP was the most sought after
professional amongst those aged 30 to 40 and men. Women mainly sought the professional help of
a gynaecologist.
30
Key findings
• Approximately 78% of the respondents have had vaginal and/or anal sex. The mean age at
first sexual intercourse is 18. Men chose a younger partner on average. About 41% of those
aged 16 to 18 report that they have had sexual intercourse at least once.
• Overall 40.7% of sexually active respondents report that they had known their partner a few
months before having sexual intercourse the first time, and 6.1% saying that they had just
met their partner. Three times more men than women report having just met their first
sexual partner or knowing them for a few weeks.
• When asked the main reasons for first sexual intercourse, 47.5% of respondents report that
they were in love, 44.7% stated that it was a natural follow on in the relationship and 30.4%
said that they felt that they were at the right age.
• In the 16-18 age group the proportion reporting that they were under the influence of
alcohol/drugs when having sexual intercourse for the first time is 6.3%. When compared to
the other two age groups, this is the highest proportion.
• A greater proportion of men compared to women state that they wanted to lose their
virginity, were curious or got carried away their first time, while women more than men
state that they were in love or gave into their partners wishes.
• Overall 7% more women than men report that they did not expect their first sexual
intercourse to happen. Amongst women the proportion saying they regret their first sexual
intercourse as well as the proportion saying they sort of regret it, is double that of men.
• 40.9% of respondents report that they discussed contraception before their first sexual
intercourse. The majority say they used a condom during their first sexual intercourse
(44.4%) however 32.3% say they used withdrawal method and 30.1% used no contraception
at all. No contraception was highest in the 16 to 18 year old age group at 36.4%.
• The majority of respondents report having 1 sexual partner in the last 6 months (72.8%) and
in the last year (71.2%). Multiple partners in the last 6 months and last year were more
common amongst the younger age groups and men.
• When looking at respondents with multiple partners in the last 6 months, 31.5% said that
they used a condom during their last sexual intercourse.
• Overall 9.1% of men and 21.7% of women report having suffered from a frequent sexual
dysfunction. These were more common in the 16-18 age group. Of those reporting a
dysfunction, 8.9% state that they sought some form of professional help to deal with the
problem and the large majority of these stated that they sought the assistance of a medical
practitioner.
31
Refer to tables 12 to 18 and figures 3 to 10 in the Annex of Tables & Figures for detailed
information outlined in this chapter.
32
7. Sexual health services

Knowledge and prevalence of sexually acquired infections
In total, 87.5% of respondents stated that they have heard of sexually acquired infections (SAIs).
This proportion was highest amongst those aged 16 to 18 (94.9%), women (92.9%) and those with a
tertiary level of education (97.8%). In total 6.6% of the respondents reported that they were told by
a medical professional that they had an SAI. This proportion was highest amongst those aged 19 to
29 at 10.2%. There were no differences by gender and educational level.
When asked to identify the signs and symptoms of SAIs, a total 68.6% of respondents correctly
identified rash/inflammation in the genital area as a symptom. A further 59% identified unusual
discharge from genital organs as a symptom, 58% identified genital warts and pain during urination
respectively and 47.5% identified ulcers/sores in the genital area as another symptom. A smaller
proportion identified spotting as a possible sign of an SAI. Only 13.6% correctly identified that SAIs
may have no symptoms. A further 23% erroneously chose bloating as a sign of an SAI followed by
smaller proportions choosing vomiting, headache and high blood pressure. The proportion of
women that correctly identified the signs and symptoms was greater than that of men. Furthermore
a greater proportion of those with a tertiary level of education were able to correctly identify the
signs and symptoms of SAIs. There was no distinguishable pattern by age, with proportions varying
by age group depending on the possible sign or symptom.
Knowledge about present sexual health services
Respondents were asked if they knew what a Genitourinary Clinic (GU) is in order to see if they were
aware of the name of the free sexual health services presently offered to the public. In total 55.5%
of respondents reported that they know what a GU clinic is. This proportion was highest amongst
the 30-40 age group (61.8%) and lowest amongst the 16-18 age group. Women were considerably
more aware of what a GU clinic is when compared to men and higher educational level was also
associated with better awareness of the GU clinic.
When asked if they were aware that there are free services offered for the testing of SAIs, 63% said
‘yes’ suggesting that a proportion of respondents were not aware of the name of this service. The
proportion was highest amongst the 30-40 age group, women and those with a tertiary level of
education.
33
When asked if they knew where the service is located, 61.5% correctly indicated that it is in Sir Paul
Boffa Hospital9 while 34.2% stated that it is in Mater Dei Hospital. Similar to the previous questions
a larger proportion of women and those with a tertiary level of education were aware of the location
of the service.
Desired qualities of sexual health services
Respondents were given a list of 14 possible features of a sexual health service and asked to rate
which features they thought were “very important”, “quite important” or “not important”.
Respondents were also given the option “don’t know”.
Overall the top five features selected as very important by respondents were confidentiality (94%),
tests for HIV and other SAIs (82.7%), friendly atmosphere and staff easy to talk to (78.9%), advice
about difficulties performing sexually (59.1%) and pregnancy testing/unplanned pregnancy
counselling (57.7%). Across all the age groups, the three top features are the same. Those aged
between 30 and 40 value a friendly atmosphere (82.7%), advice about difficulties performing
sexually (63.5%), not likely meeting someone they know (55.9%) , doctor/nurse of same gender
(51.9%) and advice on relationships (50%) more than their younger counterparts. On the other hand
the younger respondents’ value free contraception (34.2%) and staff of the same age (26%) more
than their older counterparts.
There were no major gender differences in preferred features, though 51.1% of women think it is
very important to have a nurse/doctor of same gender compared to 40.4% of men and 58.8% of
women think one should be able to attend clinic regardless of age as compared to 49.2% of men.
Amongst men however 22.6% think it is very important that there is staff of the same age compared
to 13.7% of women. When comparing educational levels, apart from the top 3 features which score
highly in all education groups, there is a differing pattern in what respondents view as important. Of
those with a secondary level of education, 67.4% think that it is very important that advice is
provided on difficulties in performing sexually, 60.2% prefer a doctor/nurse of same gender, 45.1%
wish for someone other than a nurse/doctor to talk to and 57.5% would like advice on relationships.
On the other hand amongst those with a tertiary level of education, 67% think one should be able to
attend clinic regardless of age, 61.2% believe there should be no need for a referral by your private
GP and 61.2% think you should be able to go without an appointment.
9
At the time of the survey fieldwork the GU clinic was still located in Sir Paul Boffa Hospital
34
Key findings
• 87.5% of respondents stated that they have heard of sexually acquired infections (SAIs),
particularly those aged 16 to 18 (94.9%), women (92.9%) and those with a tertiary level of
education (97.8%).
• 6.6% reported being diagnosed with an SAI by a medical professional.
• The most common symptom of an SAI that respondents correctly identified was
rash/inflammation in the genital area (68.6%). Only 13.6% correctly identified that SAIs may
have no symptoms.
• The proportion of women that correctly identified the signs and symptoms of SAIs was
greater than that of men. Furthermore a greater proportion of those with a tertiary level of
education were able to correctly identify the signs and symptoms of SAIs.
• 55.5% of respondents reported that they know what a GU clinic is. 63% said they knew
that there are free services for the testing of SAIs suggesting that a proportion of
respondents were not aware of the name of this service.
• Overall the top five features selected as very important by respondents were confidentiality
(94%), tests for HIV and other SAIs (82.7%), friendly atmosphere and staff easy to talk to
(78.9%), advice about difficulties performing sexually (59.1%) and pregnancy
testing/unplanned pregnancy counselling (57.7%).
Refer to tables 19 to 26 and figure 11 in the Annex of Tables & Figures for detailed information
outlined in this chapter.
35
ANNEX OF TABLES AND FIGURES
Table 1: Who teenagers report taught them about certain aspects of sexuality and sexual behaviour
Whom you learnt from about the following topics
Puberty Reproductive systems Other aspects of sexual behaviour
Total Men Women Total Men Women Total Men Women

Mother 33.5% 22.4% 44.7% 15.5% 12.9% 18.2% 10.4% 10.1% 10.7%
Father 2.8% 4.9% 0.7% 3.8% 4.8% 2.8% 2.4% 4.1% 0.7%
Grandfather 0.0% 0.0% 0.0% 0.7% 1.4% 0.0% 0.0% 0.0% 0.0%
Grandmother 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%
Brother/sister 1.8% 2.8% 0.7% 0.7% 0.7% 0.7% 3.8% 2.7% 5.0%
Friend 12.3% 14.0% 10.6% 8.3% 9.5% 7.0% 37.8% 38.5% 37.1%
Teacher 45.1% 52.4% 37.6% 64.8% 64.5% 65.0% 29.9% 31.8% 27.9%
Counsellor 0.4% 0.7% 0.0% 2.1% 2.0% 2.1% 2.1% 1.4% 2.9%
Doctor 0.0% 0.0% 0.0% 0.3% 0.7% 0.0% 0.7% 0.7% 0.7%
Priest 0.4% 0.7% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%
Youth worker 0.7% 1.4% 0.0% 0.3% 0.7% 0.0% 1.7% 1.4% 2.1%
Guest speaker 1.1% 0.0% 2.1% 1.0% 0.7% 1.4% 1.7% 1.4% 2.1%
None 1.4% 0.0% 2.8% 1.0% 0.7% 1.4% 8.0% 6.1% 10.0%
Other 0.7% 0.7% 0.7% 1.4% 1.4% 1.4% 1.4% 2.0% 0.7%
37
Table 2: Who teenagers report they preferred taught them about certain aspects of sexuality and sexual behaviour
Whom you wish you learnt from about the following topics
Mother 37.4% 21.9% 53.0% 24.2% 13.2% 35.1% 17.0% 9.8% 24.5%
Father 3.6% 7.3% 0.0% 5.0% 8.6% 1.3% 4.0% 6.5% 1.4%
Grandfather 0.0% 0.0% 0.0% 0.3% 0.7% 0.0% 0.3% 0.7% 0.0%
Grandmother 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.7% 0.0% 1.4%
Brother/sister 1.3% 0.7% 2.0% 1.0% 1.3% 0.7% 2.7% 3.9% 1.4%
Friend 10.6% 14.6% 6.6% 11.3% 13.2% 9.3% 21.7% 24.8% 18.4%
Teacher 32.8% 42.4% 23.2% 43.7% 50.3% 37.1% 26.6% 31.4% 21.8%
Counsellor 2.6% 2.0% 3.3% 3.3% 2.6% 4.0% 5.7% 6.5% 4.8%
Doctor 2.6% 2.6% 2.6% 2.6% 2.6% 2.6% 1.0% 1.3% 0.7%
Priest 0.7% 1.3% 0.0% 0.3% 0.7% 0.0% 1.0% 1.3% 0.7%
Youth worker 4.0% 2.0% 6.0% 5.0% 3.3% 6.6% 7.7% 4.6% 10.9%
Guest speaker 1.7% 2.6% 0.7% 1.0% 1.3% 0.7% 3.7% 3.9% 3.4%
None 2.6% 2.6% 2.6% 2.3% 2.0% 2.6% 6.3% 3.9% 8.8%
Other 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 1.7% 1.3% 2.0%
38
Table 3: Where teenagers report they learnt about certain aspects of sexuality and sexual behaviour
Where you learnt about the following topics

Home 24.2% 17.5% 31.1% 12.1% 10.7% 13.4% 11.3% 10.2% 12.4%
School 68.9% 74.0% 63.5% 82.9% 82.6% 83.2% 55.5% 56.5% 54.5%
Youth centre 3.3% 4.5% 2.0% 3.0% 4.0% 2.0% 6.8% 6.8% 6.9%
Health clinic 0.3% 0.6% 0.0% 0.0% 0.0% 0.0% 0.3% 0.0% 0.7%
Muzew 1.3% 0.6% 2.0% 0.3% 0.0% 0.7% 1.4% 0.7% 2.1%
Other faith/church group 0.0% 0.0% 0.0% 0.3% 0.7% 0.0% 0.7% 0.7% 0.7%
Places of entertainment 2.0% 2.6% 1.4% 0.7% 0.7% 0.7% 19.9% 22.4% 17.2%
Other 0.0% 0.0% 0.0% 0.7% 1.3% 0.0% 4.1% 2.7% 5.5%
Table 4: Where teenagers wished they learnt about certain aspects of sexuality and sexual behaviour
Where you wished you learnt about the following topics

Home 38.9% 28.4% 49.7% 23.8% 14.7% 33.1% 19.9% 13.5% 26.5%
School 51.0% 58.7% 43.0% 61.2% 66.0% 56.3% 51.0% 54.2% 47.6%
Youth centre 3.3% 5.2% 1.3% 7.2% 9.6% 4.6% 9.6% 11.0% 8.2%
Health clinic 2.6% 2.6% 2.6% 2.9% 2.6% 3.3% 3.3% 1.9% 4.8%
Muzew 1.3% 1.9% 0.7% 1.3% 2.6% 0.0% 1.0% 1.3% 0.7%
Other faith/church group 0.7% 0.6% 0.7% 0.0% 0.0% 0.0% 1.7% 1.9% 1.4%
Places of entertainment 2.3% 2.6% 2.0% 3.3% 4.5% 2.0% 11.3% 13.5% 8.8%
Other 0.0% 0.0% 0.0% 0.3% 0.0% 0.7% 2.3% 2.6% 2.0%
39
Table 5: Which resources teenagers report were used when they learnt about certain aspects of sexuality and sexual behaviour
What resources were used when you learnt about the following topics
Television 10.1% 8.2% 12.0% 5.5% 6.1% 4.9% 8.5% 9.4% 7.6%
Books/magazines 24.0% 22.6% 25.4% 28.9% 32.4% 25.2% 18.1% 16.1% 20.1%
Internet 19.4% 24.0% 14.8% 14.4% 15.5% 13.3% 21.8% 22.8% 20.8%
Leaflets 4.2% 2.7% 5.6% 6.5% 3.4% 9.8% 5.1% 7.4% 2.8%
Films/videos 10.8% 11.6% 9.9% 11.0% 9.5% 12.6% 13.0% 12.1% 13.9%
Radio 0.0% 0.0% 0.0% 0.7% 1.4% 0.0% 0.7% 1.3% 0.0%
Billboards 0.0% 0.0% 0.0% 0.3% 0.7% 0.0% 0.0% 0.0% 0.0%
Posters 0.7% 1.4% 0.0% 2.1% 2.7% 1.4% 1.7% 2.0% 1.4%
Talks/seminars 16.7% 12.3% 21.1% 19.2% 15.5% 23.1% 15.4% 13.4% 17.4%
No resources 11.1% 12.3% 9.9% 8.6% 8.1% 9.1% 11.9% 10.1% 13.9%
Others 3.1% 4.8% 1.4% 2.7% 4.7% 0.7% 3.8% 5.4% 2.1%
40
Table 6: Which resources teenagers report they preferred were used when learnt about certain aspects of sexuality and sexual behaviour
What resources you wish were used when you learnt about the following topics
Television 10.3% 13.2% 7.4% 7.7% 10.7% 4.7% 7.2% 9.5% 4.8%
Books/magazines 23.0% 21.9% 24.2% 21.7% 20.8% 22.7% 14.0% 10.2% 17.8%
Internet 20.7% 23.8% 17.4% 18.4% 21.5% 15.3% 25.3% 29.3% 21.2%
Leaflets 5.0% 4.0% 6.0% 5.7% 4.7% 6.7% 2.7% 2.0% 3.4%
Films/videos 14.3% 14.6% 14.1% 18.1% 19.5% 16.7% 16.4% 19.7% 13.0%
Radio 0.3% 0.7% 0.0% 0.7% 0.7% 0.7% 0.0% 0.0% 0.0%
Billboards 0.0% 0.0% 0.0% 1.0% 1.3% 0.7% 0.3% 0.0% 0.7%
Posters 0.0% 0.0% 0.0% 1.3% .7% 2.0% 1.0% .7% 1.4%
Talks/seminars 18.3% 15.9% 20.8% 18.4% 14.8% 22.0% 21.5% 17.7% 25.3%
No resources 7.0% 4.0% 10.1% 5.7% 2.7% 8.7% 8.9% 6.1% 11.6%
Others 1.0% 2.0% 0.0% 1.3% 2.7% 0.0% 2.7% 4.8% 0.7%
41
Figure 1:: Respondents' knowledge

knowledge about certain aspects of sexual health and reproduction
If during intercourse the man withdraws to

ejaculate outside the woman's vagina, there is…
The contraceptive pill always prevents against

pregnancy
Condoms always prevent sexually transmitted

infections
A girl cannot become pregnant the first time she

has sexual intercourse
It's against the law to have sex with a girl who is

under 16
If a girl is under 16 and asks for the contraceptive

pill, the girl's doctor must tell her parents
You can't buy condoms if you are less than 16

years old
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
TRUE FALSE Don't Know
Figure 2:: Respondents' attitudes towards certain aspects of sexual behaviour and sexuality
I feel that I can encourage the person I have

sexual intercourse with to use a condom
I intend to use a condom the next time I have

sexual intercourse
Most of my close friends have had sexual

intercourse
I consider "one nights stands" to be ok
Once you had sex it is harder to say "no" the next

time
You should be in love before you have sexual

intercourse
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree
42
Table 7: Respondents knowledge about certain aspects of sexual health and reproduction (a)
If a girl is under 16 and asks for A girl cannot become pregnant

You can't buy condoms if you are It's against the law to have sex
the contraceptive pill, the girl's the first time she has sexual
less than 16 years old with a girl who is under 16
doctor must tell her parents intercourse
True False Don't know True False Don't know True False Don't know True False Don't know
Total 39.5% 43.7% 16.8% 66.5% 19.4% 14.1% 87.9% 8.9% 3.3% 22.2% 68.4% 9.4%
16 - 18 31.4% 46.5% 22.0% 61.3% 21.3% 17.5% 76.1% 16.4% 7.5% 19.1% 67.5% 13.4%
19 - 29 37.6% 42.2% 20.2% 65.2% 20.0% 14.8% 89.4% 8.5% 2.1% 18.9% 68.3% 12.7%
30 - 40 44.4% 44.4% 11.2% 69.8% 17.9% 12.3% 90.2% 6.7% 3.1% 27.1% 68.8% 4.1%
Male 40.1% 44.2% 15.7% 58.1% 26.0% 15.9% 82.7% 13.0% 4.3% 22.7% 66.7% 10.6%
Female 38.9% 43.3% 17.8% 74.9% 12.8% 12.3% 93.1% 4.8% 2.1% 21.6% 70.6% 7.8%
Up to secondary 49.2% 39.1% 11.7% 66.9% 23.3% 9.8% 82.5% 12.9% 4.5% 33.7% 57.3% 9.1%
Post-secondary 34.9% 43.5% 21.6% 70.5% 14.0% 15.4% 90.7% 6.3% 3.0% 16.1% 70.6% 13.3%
Tertiary 26.2% 53.6% 20.2% 59.8% 19.1% 21.1% 94.5% 4.3% 1.2% 7.2% 88.4% 4.4%
43
Table 8: Respondents knowledge about certain aspects of sexual health and reproduction (b)
If during intercourse the man withdraws to

Condoms always prevent sexually acquired The contraceptive pill always prevents
ejaculate outside the woman's vagina, there
infections against pregnancy
is no chance that she will get pregnant
True False Don't know True False Don't know True False Don't know
Total 31.6% 60.1% 8.3% 16.7% 78.0% 5.3% 27.5% 62.8% 9.7%
16 - 18 26.9% 66.3% 6.9% 25.8% 61.0% 13.2% 32.3% 53.8% 13.9%

19 - 29 21.9% 65.8% 12.4% 16.1% 77.8% 6.2% 27.9% 62.9% 9.3%
30 - 40 44.5% 51.5% 4.0% 14.2% 84.2% 1.6% 25.2% 66.1% 8.7%
Male 30.2% 63.0% 6.8% 20.1% 72.8% 7.0% 29.3% 62.3% 8.4%
Female 32.7% 57.3% 10.0% 13.4% 82.9% 3.7% 25.6% 63.5% 10.9%
Up to secondary 36.8% 51.7% 11.5% 18.0% 77.5% 4.5% 25.8% 61.6% 12.5%
Post-secondary 32.6% 60.5% 6.9% 20.2% 71.0% 8.8% 29.8% 60.2% 9.9%
Tertiary 19.5% 76.9% 3.6% 9.0% 89.4% 1.6% 27.5% 68.9% 3.6%
44
Table 9: Respondents attitudes towards certain aspects of sexual behaviour and sexuality (a)
You should be in love before you have sexual intercourse Once you had sex it is harder to say "no" the next time
Strongly Neither Agree Strongly Strongly Neither Agree Strongly

Agree Disagree Agree Disagree
Agree nor Disagree Disagree Agree nor Disagree Disagree
Total 39.6% 29.1% 20.0% 7.8% 3.5% 29.1% 42.9% 14.7% 12.3% 1.1%
16 - 18 47.5% 35.0% 13.1% 3.8% 0.6% 23.8% 41.9% 20.0% 13.1% 1.3%
19 - 29 34.8% 33.1% 19.3% 10.1% 2.7% 26.3% 41.3% 15.2% 15.4% 1.9%
30 - 40 42.3% 22.6% 23.2% 6.6% 5.3% 34.2% 45.1% 12.3% 8.5% 0.0%
Male 33.2% 29.4% 21.6% 8.8% 7.0% 30.9% 41.6% 15.5% 10.9% 1.1%
Female 46.0% 28.7% 18.2% 7.1% 0.0% 27.4% 44.3% 13.6% 13.8% 0.9%
Up to secondary 38.2% 23.5% 22.7% 9.3% 6.4% 31.5% 44.0% 12.9% 10.8% 0.8%
Post -secondary 38.7% 37.1% 17.4% 5.7% 1.1% 25.5% 44.0% 17.9% 11.5% 1.1%
Tertiary 44.1% 28.7% 18.1% 8.3% 0.8% 29.4% 39.3% 13.9% 16.3% 1.2%
45
Table 10: Respondents attitudes towards certain aspects of sexual behaviour and sexuality (b)
I consider "one nights stands" to be ok Most of my close friends have had sexual intercourse
Strongly Neither Agree Strongly Strongly Neither Agree Strongly

Agree Disagree Agree Disagree
Agree nor Disagree Disagree Agree nor Disagree Disagree
Total 16.6% 9.1% 23.2% 33.6% 17.5% 37.8% 40.6% 12.7% 7.7% 1.2%
16 - 18 14.0% 13.4% 26.1% 27.4% 19.1% 18.8% 37.5% 18.1% 19.3% 6.3%
19 - 29 17.3% 11.2% 20.0% 32.2% 19.4% 38.8% 41.9% 12.6% 6.2% 0.6%
30 - 40 16.7% 5.1% 25.9% 37.5% 14.7% 43.5% 40.2% 10.9% 5.1% 0.2%
Male 17.5% 16.5% 24.9% 28.5% 12.5% 40.6% 39.7% 13.5% 5.2% 0.9%
Female 15.8% 1.8% 21.1% 38.7% 22.6% 35.0% 41.2% 12.0% 10.1% 1.6%
Up to secondary 19.2% 9.6% 20.4% 40.8% 10.0% 33.2% 42.4% 14.1% 9.2% 1.2%
Post -secondary 13.8% 9.9% 22.9% 29.0% 24.3% 37.8% 38.6% 13.1% 8.9% 1.7%
Tertiary 15.2% 6.4% 28.8% 26.8% 22.8% 47.2% 40.1% 9.1% 2.8% 0.8%
46
Behaviour – National Survey Malta 2012
Figure 3:: Proportion of respondents having ever had sexual

sexual intercourse and proportion having
engaged in various sexual behaviours, by age
(Respondents could select more than one answer)
100%
90%
80%
70%
60%
50%
16 - 18
40%
19 - 29
30%
30 - 40
20%
10%
0%
Sexual Touching Oral Sex Vaginal Sex Anal Sex
Intercourse genitals
Lifetime
Figure 4:: Proportion of respondents having ever had sexual intercourse and proportion having
engaged in various sexual behaviours, by gender
90%
80%
70%
60%
50%
40% Male
30% Female
20%
10%
0%
Sexual Touching Oral Sex Vaginal Sex Anal Sex
Intercourse genitals
Lifetime
47
Behaviour – National Survey Malta 2012
Figure 5:: Attitude towards and feelings about first sexual intercourse before and after first
intercourse, by age
100%
90%
80%
70%
60%
50%
Sort of
40%
No
30%
Yes
20%
10%
0%
16 - 18 19 - 29 30 - 40 16 - 18 19 - 29 30 - 40
Expected Regretted
Figure 6:: Attitude towards and feelings about first sexual intercourse before and after first
intercourse, by gender
100%
90%
80%
70%
60%
50%
Sort of
40%
No
30%
Yes
20%
10%
0%
Male Female Male Female
Expected Regretted
48
Table 11: Respondents relationship with partner before first sexual intercourse
For how long had you known the person before having sexual intercourse the first time?
For a few For a few In a committed Living together as Engaged to be
We had just met For a few weeks Married
months years relationship a couple married
Total 6.1% 21.1% 40.7% 11.1% 16.0% 0.0% 0.7% 4.4%
16 - 18 10.7% 17.3% 50.7% 5.3% 16.0% 0.0% 0.0% 0.0%

19 - 29 5.0% 24.4% 43.1% 8.1% 17.6% 0.0% 0.4% 1.3%
30 - 40 6.4% 18.4% 36.8% 15.0% 14.3% 0.0% 1.1% 8.1%
Male 9.5% 30.8% 35.7% 9.7% 12.3% 0.0% 0.4% 1.6%

Female 2.7% 11.3% 46.5% 12.7% 19.9% 0.0% 1.0% 5.9%
Table 12: Main reasons for first sexual intercourse

Main reasons for first sexual intercourse

Wanted to I gave into Got It was I was under the
Felt I was the Friends all I was in Natural follow on
lose my Curious partners carried physically influence of
right age doing it love in relationship
virginity wishes away forced on me alcohol/drugs
Total 30.4% 15.2% 10.0% 47.5% 44.7% 21.5% 8.3% 12.4% 0.7% 3.4%
16 - 18 25.4% 19.0% 6.3% 34.9% 33.3% 19.0% 7.9% 12.7% 1.6% 6.3%
19 - 29 24.9% 22.2% 13.8% 44.3% 43.0% 26.1% 8.6% 10.1% 1.0% 4.7%
30 - 40 36.3% 8.1% 6.9% 52.2% 47.9% 17.5% 8.1% 14.5% 0.2% 1.8%
Male 33.8% 20.4% 9.8% 31.5% 46.3% 24.8% 3.3% 14.3% 0.9% 3.7%
Female 27.4% 9.9% 10.4% 65.7% 43.8% 18.4% 13.8% 10.4% 0.5% 3.2%
49
Table 13: Use of contraception during first sexual intercourse

Contraception First Time

Intra-Uterine Natural Family
None Pill Condom Withdrawal
Method Planning
Total 30.1% 5.9% 44.4% 32.3% 2.9% 0.3%
16 - 18 36.4% 5.2% 41.6% 22.1% 1.3% 1.3%

19 - 29 32.0% 5.5% 48.0% 24.4% 1.1% 0.2%
30 - 40 27.1% 6.4% 41.3% 41.9% 4.9% 0.4%
Male 33.5% 4.4% 38.9% 32.1% 1.6% 0.4%

Female 27.0% 7.4% 50.9% 32.8% 4.2% 0.2%
Table 14: Discussing contraception with present sexual partner
How easy is it to talk about contraception with the person you have sexual
intercourse with
Very easy Quite easy Quite difficult Very difficult
Total 60.1% 31.8% 6.5% 1.6%
16 - 18 32.5% 42.9% 19.5% 5.2%

19 - 29 59.0% 32.3% 7.7% 0.9%
30 - 40 65.7% 29.4% 3.2% 1.7%
Male 61.5% 31.2% 7.1% .2%

Female 58.9% 32.3% 5.8% 3.0%
50
Figure 7:: Use of contraception during most recent sexual intercourse amongst respondents with 2
or more partners in the last 6 months, by age
80%
70%
60%
50%
40%
30%
20%
10%
0%
None Pill Condom Withdrawal IUM NFP
16 - 18 19 - 29 30 - 40
Figure 8:: Use of contraception during most recent sexual intercourse amongst respondents with 2
or more partners in the last 6 months, by gender
70%
60%
50%
40%
30%
20%
10%
0%
None Pill Condom Withdrawal IUM NFP
Male Female
51
Figure 9: Frequency
uency of condom use amongst respondents with 2 or more partners in the last 6
months, by age
70%
60%
50%
40%
30%
20%
10%
0%
Always Often Sometimes Rarely Never
16 - 18 19 - 29 30 - 40
Figure 10:: Frequency of condom use amongst respondents with 2 or more partners in the last 6
months, by gender
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Always Often Sometimes Rarely Never
Male Female
52
Table 15: Number of sexual partners in last 6 months, last year and lifetime
Last 6 months Last year Lifetime

0 1 2 3-5 6 or more 0 1 2 3-5 6 or more 1 2 3-5 6 or more
Total 18.1% 72.8% 4.9% 2.1% 2.1% 13.6% 71.2% 6.5% 6.1% 2.6% 24.4% 35.9% 19.0% 20.7%
16 - 18 20.3% 56.8% 9.5% 10.8% 2.7% 15.1% 47.9% 16.4% 16.4% 4.1% 44.0% 18.7% 20.0% 17.3%
19 - 29 14.7% 71.4% 6.8% 2.9% 4.2% 10.4% 69.2% 10.8% 4.8% 4.8% 18.7% 36.5% 23.3% 21.5%
30 - 40 20.9% 76.7% 2.4% 0.0% 0.0% 16.6% 76.9% 0.7% 5.7% 0.2% 26.8% 38.1% 14.7% 20.4%
Male 14.4% 73.0% 5.5% 3.0% 4.1% 9.5% 68.8% 8.5% 8.1% 5.2% 24.3% 26.3% 19.8% 29.6%
Female 20.9% 73.3% 4.6% 1.2% 0.0% 16.6% 74.3% 4.8% 4.1% 0.2% 24.8% 45.2% 18.6% 11.4%
53
Table 16: Influence of alcohol and drug consumption on sexual behaviour
Ever used Alcohol or drugs

Ever had Ever done more
alcohol or influenced a
unprotected sex sexually than
drugs to feel decision to do
because you were planned because
comfortable something sexual
drinking or using of drinking or
with a sexual that regretted
drugs using drugs
partner later
Total 16.8% 20.6% 19.9% 11.8%
16 - 18 19.2% 21.1% 19.7% 11.8%

19 - 29 21.8% 21.4% 27.6% 19.0%
30 - 40 11.5% 20.0% 12.6% 4.6%
Male 22.0% 27.5% 24.5% 11.9%

Female 11.3% 13.8% 15.3% 12.0%
Table 17: Frequency of sexual dysfunctions and treatment
Frequently Sought help

Have suffer pain from
problems or professional
getting and discomfort for
If yes. which type of professional
maintaining during problems
an erection sexual related to
(men) intercourse performing
(women) sexually
Sex
Yes Yes Yes GP Gynaecologist Psychologist Other
therapist
Total 9.1% 21.7% 8.9% 38.3% 37.0% 8.6% 3.7% 12.3%
16 - 18 12.7% 21.3% 9.4% 37.5% 37.5% 12.5% 0.0% 12.5%

19 - 29 9.5% 24.9% 6.6% 12.1% 45.5% 12.1% 3.0% 27.3%
30 - 40 5.3% 14.9% 11.0% 60.0% 30.0% 5.0% 5.0% 0.0%
Male - - 11.3% 51.9% 16.7% 13.0% 0.0% 18.5%

Female - - 6.2% 13.8% 72.4% 0.0% 10.3% 3.4%
54
Table 18: Knowledge of SAIs, proportion having had an SAI and proportion who know what a GU
clinic is
Have you ever

Have you ever been told by a Do you know what a
heard of sexually
nurse/doctor/midwife that you had Genitourinary (GU)
acquired
a sexually acquired infection? clinic is?
infections?
Yes Yes Yes
Total 87.5% 6.6% 55.5%
16 - 18 94.9% 7.6% 47.4%

19 - 29 84.8% 10.2% 52.3%
30 - 40 88.0% 2.3% 61.8%
Male 82.2% 6.8% 46.5%

Female 92.9% 6.6% 64.0%
Up to secondary 78.0% 6.6% 49.0%

Post-secondary 92.9% 6.4% 50.7%
Tertiary 97.8% 7.1% 75.3%
Table 19: Knowledge of free SAI testing services in Malta and where they are located
Are you aware that there

are free services for the
testing and treatment of If yes, where are these services located?10
sexually acquired
infections in Malta?
Boffa Mater De
Yes Mosta HC Qormi HC Paola HC
Hospital Hospital
Total 63.0% 61.5% 34.2% 1.0% 0.7% 2.6%
16 - 18 59.5% 45.5% 43.2% 5.7% 3.4% 2.3%

19 - 29 59.5% 73.6% 24.7% 0.3% 0.3% 1.0%
30 - 40 68.3% 54.2% 40.9% 0.3% 0.3% 4.3%
Male 56.4% 58.5% 38.5% 1.7% 0.7% 0.7%

Female 69.0% 65.1% 30.2% 0.5% 0.3% 4.0%
Up to
59.4% 54.2% 39.1% 1.3% 0.7% 4.7%
secondary
Post-
57.0% 61.5% 33.7% 2.0% 1.0% 2.0%
secondary
Tertiary 78.7% 72.3% 27.7% 0.0% 0.0% 0.0%
10
When the survey fieldwork was conducted the GU clinic was still located within Sir Paul Boffa Hospital
55
Table 20: Knowledge of signs and symptoms of SAIs
What are the signs and symptoms of SAIs?

Unusual
Ulcers/sores High
No Genital Rash/Inflammation discharge Pain during
Spotting Headache Bloating in genital Vomiting Blood
symptoms Warts in genital area from urination
area Pressure
penis/vagina
Total 13.6% 58.0% 32.6% 6.5% 68.6% 59.3% 23.0% 58.2% 47.5% 8.2% 4.2%
16 - 18 11.9% 54.4% 37.5% 11.9% 65.0% 47.8% 22.6% 51.9% 44.7% 9.4% 8.2%
19 - 29 13.2% 60.9% 38.6% 6.7% 74.8% 61.2% 25.4% 61.8% 52.2% 6.0% 3.6%
30 - 40 14.6% 55.9% 23.8% 4.7% 62.7% 61.0% 20.3% 56.1% 43.0% 10.5% 3.4%
Male 10.1% 55.7% 29.5% 8.1% 64.2% 49.9% 27.4% 54.7% 45.1% 13.3% 5.5%
Female 17.1% 61.3% 35.9% 5.1% 73.7% 69.3% 18.9% 62.4% 50.5% 3.4% 2.7%
Up to
8.2% 50.8% 26.7% 6.3% 59.1% 54.2% 18.9% 54.2% 40.5% 10.9% 5.2%
secondary
Post -
15.4% 54.0% 34.5% 7.0% 68.1% 58.3% 24.2% 53.6% 45.6% 5.7% 3.9%
secondary
Tertiary 21.1% 77.8% 41.1% 6.3% 87.8% 70.7% 29.3% 72.2% 64.1% 5.9% 1.9%
56
Figure 11:: Desired features of sexual health services amongst total
Provides advice about difficulties in performing

sexually
Tests for HIV/Other STIs
Pregnancy testing/Unplanned pregnancy

counselling
Having staff your own age
Being able to go without an appointment
Someone else other than a doctor/nurse
Friendly atmosphere and staff easy to talk to
No need for referral by your private GP
Can attend clinic regardless of age
Doctor/Nurse of same gender
Not likely to meet someone you know
Confidentiality
Free contraception
Advice on relationships
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Very Important Quite Important Not Important Don't Know
57
Table 21: Desired features of sexual health services (a)

Advice on relationships Free contraception
Very Quite
Not Important Don't Know Very Important Quite Important Not Important Don't Know
Important Important
Total 44.0% 40.9% 12.6% 2.5% 30.4% 36.8% 26.3% 6.5%
16 - 18 44.8% 42.9% 10.4% 1.9% 34.2% 35.5% 22.6% 7.7%

19 - 29 38.5% 42.4% 15.1% 3.9% 33.7% 36.0% 22.3% 8.1%
30 - 40 50.0% 38.5% 10.4% 1.1% 25.2% 38.3% 32.3% 4.2%
Male 41.5% 45.4% 9.9% 3.2% 30.6% 37.0% 24.2% 8.2%

Female 46.2% 36.6% 15.4% 1.9% 30.6% 36.9% 27.4% 5.1%
Up to secondary 57.5% 33.7% 7.2% 1.6% 29.9% 40.1% 23.0% 7.0%

Post -secondary 37.5% 46.1% 12.6% 3.8% 33.5% 31.9% 26.0% 8.6%
Tertiary 26.8% 47.2% 23.4% 2.6% 26.8% 37.5% 32.7% 3.0%
Table 22: Desired features of sexual health services (b)

Confidentiality Not likely to meet someone you know Doctor/Nurse of same gender
Very Quite Not Don't Very Quite Not Don't Very Quite Not Don't
Important Important Important Know Important Important Important Know Important Important Important Know
Total 94.0% 4.1% .9% 1.1% 49.6% 31.8% 13.9% 4.7% 45.4% 26.1% 27.7% 0.8%
16 - 18 88.4% 11.0% 0.0% 0.6% 38.1% 45.2% 11.6% 5.2% 42.9% 31.4% 23.7% 1.9%
19 - 29 91.4% 4.6% 1.8% 2.2% 47.6% 30.6% 17.6% 4.3% 40.7% 30.7% 27.7% 0.9%
30 - 40 98.7% 1.3% 0.0% 0.0% 55.9% 28.7% 10.3% 5.1% 51.9% 18.8% 29.0% 0.2%
Male 90.1% 6.1% 1.7% 2.1% 51.0% 31.0% 14.4% 3.6% 40.4% 28.1% 30.8% 0.7%
Female 97.6% 2.2% 0.0% 0.2% 47.8% 32.7% 13.4% 6.1% 51.1% 24.3% 23.9% 0.7%
Up to secondary 92.8% 4.0% 1.5% 1.7% 50.5% 27.6% 14.2% 7.7% 60.2% 17.0% 22.6% 0.2%
Post -secondary 93.1% 5.8% 0.5% 0.5% 44.4% 36.8% 15.6% 3.2% 37.4% 33.2% 27.8% 1.6%
Tertiary 97.4% 1.9% 0.0% 0.7% 55.6% 32.8% 10.4% 1.1% 29.2% 33.3% 37.1% 0.4%
58
Table 23: Desired features of sexual health services (c)
Friendly atmosphere and staff easy to talk

Can attend clinic regardless of age No need for referral by your private GP
to
Total 53.6% 29.8% 10.5% 6.0% 43.5% 33.7% 17.6% 5.2% 78.9% 17.5% 2.9% 0.7%
16 - 18 53.2% 36.4% 5.8% 4.5% 45.4% 32.2% 15.1% 7.2% 69.9% 23.5% 4.6% 2.0%
19 - 29 54.6% 28.7% 10.8% 6.0% 45.7% 32.3% 14.2% 7.8% 78.1% 16.8% 4.5% 0.6%
30 - 40 52.7% 28.9% 11.8% 6.6% 40.1% 35.9% 22.6% 1.3% 82.7% 16.3% .6% 0.4%
Male 49.2% 35.8% 9.7% 5.3% 41.7% 32.2% 21.5% 4.6% 76.8% 17.8% 4.6% 0.9%
Female 58.8% 24.2% 10.3% 6.7% 45.5% 34.4% 14.3% 5.8% 82.0% 16.3% 1.2% 0.5%
Up to
46.7% 35.8% 10.0% 7.5% 30.8% 39.0% 24.3% 6.0% 82.2% 15.1% 2.3% 0.4%
secondary
Post -
53.7% 28.8% 11.0% 6.5% 48.0% 31.3% 15.0% 5.7% 74.3% 19.8% 4.3% 1.6%
secondary
Tertiary 67.0% 19.5% 11.2% 2.2% 61.2% 27.2% 9.0% 2.6% 79.2% 19.0% 1.9% 0.0%
59
Table 24: Desired features of sexual health services (d)
Being able to go without an

Someone else other than a doctor/nurse Having staff your own age
appointment
Total 33.0% 29.0% 32.9% 5.1% 46.1% 35.2% 13.8% 4.9% 18.0% 27.9% 50.8% 3.3%
16 - 18 35.5% 41.3% 18.7% 4.5% 45.4% 32.2% 15.1% 7.2% 26.0% 22.7% 45.5% 5.8%
19 - 29 30.2% 35.0% 29.2% 5.6% 45.7% 32.3% 14.2% 7.8% 18.7% 26.5% 49.9% 4.9%
30 - 40 35.4% 17.9% 41.9% 4.8% 40.1% 35.9% 22.6% 1.3% 14.5% 31.2% 53.6% 0.7%
Male 33.3% 26.7% 34.5% 5.5% 41.7% 32.2% 21.5% 4.6% 22.6% 31.4% 41.9% 4.1%
Female 32.6% 31.3% 31.1% 5.0% 45.5% 34.4% 14.3% 5.8% 13.7% 24.4% 59.5% 2.4%
Up to
45.1% 18.6% 31.8% 4.5% 30.8% 39.0% 24.3% 6.0% 20.6% 29.4% 46.5% 3.5%
secondary
Post -
24.5% 37.4% 31.2% 7.0% 48.0% 31.3% 15.0% 5.7% 17.0% 27.0% 51.8% 4.3%
secondary
Tertiary 21.3% 37.5% 36.7% 4.5% 61.2% 27.2% 9.0% 2.6% 14.9% 26.1% 57.8% 1.1%
60
Table 25: Desired features of sexual health services (e)
Pregnancy testing/Unplanned pregnancy Provides advice about difficulties in

Tests for HIV/Other SAIs
counselling performing sexually
Total 57.7% 33.6% 5.3% 3.4% 82.7% 15.6% 1.1% 0.5% 59.1% 32.8% 6.4% 1.7%
16 - 18 54.8% 39.4% 3.9% 1.9% 74.8% 20.6% 3.2% 1.3% 49.4% 39.0% 9.1% 2.6%
19 - 29 63.4% 27.9% 4.8% 3.9% 84.1% 13.8% 1.3% 0.8% 58.0% 33.6% 6.2% 2.1%
30 - 40 52.3% 37.9% 6.4% 3.4% 83.8% 16.0% 0.2% 0.0% 63.6% 29.8% 5.8% 0.9%
Male 55.8% 34.0% 6.1% 4.1% 83.5% 14.7% 1.2% 0.5% 60.6% 32.1% 5.9% 1.4%
Female 60.2% 32.4% 4.7% 2.8% 82.9% 15.5% 1.0% 0.5% 58.7% 32.1% 7.1% 2.1%
Up to
58.7% 30.7% 5.0% 5.6% 83.7% 15.3% 0.8% 0.2% 67.4% 26.3% 5.7% 0.6%
secondary
Post -
57.8% 35.3% 5.1% 1.9% 80.5% 17.6% 1.1% 0.8% 54.3% 35.0% 8.0% 2.7%
secondary
Tertiary 55.8% 36.8% 6.3% 1.1% 84.0% 13.4% 1.9% 0.7% 50.2% 41.3% 5.9% 2.6%
61

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6H[XDO.

National sexual health survey amongst the Maltese population aged 16 to 40

Directorate for Health Information and Research

Ministry for Health

Sexual health requires a positive, respectful approach to

Hon. Dr. Godfrey Farrugia

Dr. Neville Calleja Dr. Natasha Azzopardi Muscat

This report has been compiled by Ms. Dorothy Gauci.

4. Sexual education amongst 16 to 18 year olds ...................................................................... 18

ANNEX OF TABLES AND FIGURES ................................................................................................ 36

∗ Social and behavioural factors

∗ Sexual health promotion and education

Aims and objectives of this study

The questionnaire covered the following five sections:

a) Sources of information about sexual and reproductive health (sex education)

Description of the study population

4. Sexual education amongst 16 to 18 year olds

Learning about puberty

Learning about the reproductive systems of men and women

5. Knowledge about sexual health and attitudes towards

First experience of sexual intercourse

Recent experience of sexual intercourse

Risky sexual behaviour

7. Sexual health services

Knowledge about present sexual health services

Desired qualities of sexual health services

Whom you learnt from about the following topics

Puberty Reproductive systems Other aspects of sexual behaviour

Total Men Women Total Men Women Total Men Women

Where you learnt about the following topics

Where you wished you learnt about the following topics

Figure 1:: Respondents' knowledge

If during intercourse the man withdraws to

The contraceptive pill always prevents against

Condoms always prevent sexually transmitted

A girl cannot become pregnant the first time she

It's against the law to have sex with a girl who is

If a girl is under 16 and asks for the contraceptive

You can't buy condoms if you are less than 16

TRUE FALSE Don't Know

I feel that I can encourage the person I have

I intend to use a condom the next time I have

Most of my close friends have had sexual

I consider "one nights stands" to be ok

Once you had sex it is harder to say "no" the next

You should be in love before you have sexual

If a girl is under 16 and asks for A girl cannot become pregnant

If during intercourse the man withdraws to

16 - 18 26.9% 66.3% 6.9% 25.8% 61.0% 13.2% 32.3% 53.8% 13.9%

Strongly Neither Agree Strongly Strongly Neither Agree Strongly

Strongly Neither Agree Strongly Strongly Neither Agree Strongly

Figure 3:: Proportion of respondents having ever had sexual

16 - 18 10.7% 17.3% 50.7% 5.3% 16.0% 0.0% 0.0% 0.0%

Male 9.5% 30.8% 35.7% 9.7% 12.3% 0.0% 0.4% 1.6%

Table 12: Main reasons for first sexual intercourse

Main reasons for first sexual intercourse

Table 13: Use of contraception during first sexual intercourse

Contraception First Time

16 - 18 36.4% 5.2% 41.6% 22.1% 1.3% 1.3%

Male 33.5% 4.4% 38.9% 32.1% 1.6% 0.4%

Table 14: Discussing contraception with present sexual partner

16 - 18 32.5% 42.9% 19.5% 5.2%

Male 61.5% 31.2% 7.1% .2%