The State of Sexual Health in United States of America in 2024: Results from the World Health Organization's Sexual Health Survey (SHAPE).

Abstract

A cross-sectional online survey conducted in July 2024 assessed sexual health in the U.S. using the World Health Organization's Sexual Health Assessment of Practices and Experiences (SHAPE) questionnaire. The study included 2555 adults aged 18-94 years, recruited through Prodege's opt-in research panel to reflect U.S. demographic diversity. Measures captured sexual knowledge, communication, attitudes, behaviors, use of sexual health services, and adverse outcomes, aligned with four sexual health framework objectives. Results showed high sexual wantedness (89%) and pleasure (87%) during the most recent sexual encounter but moderate overall satisfaction (56%). Gender differences emerged: women and gender-diverse participants reported lower pleasure, higher sexual violence exposure, and reduced safety in public spaces compared to men. Testing for HIV and other STIs was suboptimal, with 50% and 47% of participants never tested, respectively. Adverse outcomes included self-reported unintended pregnancy (40%), adolescent pregnancy (19%), and HIV prevalence of 3%. Sexual health communication was more common with partners (49%) than healthcare providers (31%). These findings reveal persistent inequities and limited progress toward equitable sexual health in the U.S. Strengthened national strategies, comprehensive and inclusive sexuality education, expanded access to competent and inclusive care, and improved surveillance are urgently needed to advance sexual health for all populations.