1. w w w. h a r r i s i n t e r a c t i v e. c o m ©2007, Harris Interactive Inc. All rights reserved. Womens Sexual Health Survey Prepared for: Association of Reproductive Health Professionals (ARHP) HealthyWomen Presented by Michele Salomon Allison Dickin Sr. Research Director Sr. Research Associate June 5, 2009

2. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Background & Objectives. The Association of Reproductive Health Professionals (ARHP), in partnership with HealthyWomen (HW), commissioned Harris Interactive to conduct an online survey to explore womens attitudes, behaviors and perceptions regarding their sexuality. – An additional focus of this research is on sexual issues women may experience, including lack of desire, pain with intercourse, inability to become aroused, inability to have an orgasm, excessive desire, and vaginal dryness. The goal of this research is to deepen ARHP and HWs existing knowledge to further enable these organizations to foster education, outreach and understanding to help women to feel comfortable with their sexuality and to empower them to communicate openly with their partners and health care providers about sex and sexuality issues. 2

3. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Sample & Methodology. This survey was conducted online within the United States by Harris Interactive on behalf of ARHP and HW between March 4-13, 2009 among 1,200 women aged 18-50 who reside in the U.S. Surveys were conducted in both English and Spanish. A total of 130 surveys were completed in Spanish. Surveys were weighted as need by age, race, education, income and region to reflect the composition of the female US population aged 18-50 year old. The survey was 16 minutes in length. 3

4. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Executive Summary 4 ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E

5. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Key Findings Women consider their sexual health important, but it is unlikely to be their top priority. Regardless of whether they have experienced sexual issues, women have similar expectations about how often women should engage in sexual activity to be sexually healthy. – However, about half of women (in both groups) believe they do not engage in sexual activity frequently enough. Seven in ten women have experienced at least one sexual issue with roughly one in five being extremely or very concerned about this. – However, nearly 4 in 10 have done nothing to address the issues they experienced. While many women say they would be comfortable speaking to a doctor about their sexual health, less than 1 in 5 women who experienced a sexual issue have done so. – However, women who have visited a health care provider about a sexual issue are more likely to have used any kind of treatment.

6. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Detailed Findings 6 ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E

7. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E General Sexual Health Attitudes & Perceptions 7 ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E

8. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Contributors to Life Satisfaction. While financial security and physical health are most likely ranked first in terms of life satisfaction, a satisfying sex life comes ahead of career satisfaction and home ownership. Rank Order of Aspect of Life Satisfaction Total Has FSD No FSD Good physical health111 Having financial security212 Staying mentally healthy333 Getting married/finding a partner444 Having children555 Having a satisfying sex life667 Being satisfied with my career785 Owning a home777 Traveling999 Having a thriving social life10 8 BASE: All Qualified Respondents (n=1,210) Q701-Q710. Please indicate which is the most important to your life satisfaction. Women who experience sexual desire more often are more likely to rank a satisfying sex life as more important to life satisfaction (this group ranks a satisfying sex life 5 of 10, compared to a rank of 8 of 10 among women who experience desire weekly or less often). Women who believe their sexual health is very or extremely important to their overall health give a satisfying sex life a mean rank of 5, compared to a mean rank of 8 among women who consider their sexual health not very or not at all important to their overall health.

9. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Importance of Sex to Relationship Satisfaction. Most women see sex as important to their relationship satisfaction, with nearly one in ten saying it is extremely important. 9 BASE: Qualified Respondents in relationship (n=861) Q730 How important is your sex life to your relationship satisfaction? Extremely/Very Important (NET) 41% Exp. Sexual Issue 38% No Sexual Issue 47% Not Very/Not at All Important (NET) 16% Exp. Sexual Issue 17% No Sexual Issue 12% Extremely/Very Important Has children45%* No children32% Experience desire more than weekly 50%* Experience desire weekly or less31% Satisfied with sex life46%* Not satisfied with sex life24% Sexual health important 46%* Sexual health not important13% Excellent/Very good physical health43%* Fair/Poor physical health28% Excellent/Very good mental health43%* Fair/Poor mental health28% Excellent/Very good body image45%* Fair/Poor body image35%

10. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Importance of Sexual Health to Overall Health. Having experienced a sexual health issue has little impact on womens views about the importance of sexual health to overall health; however, other variables, such as being in a relationship, make women significantly more likely to say that sexual health is important. 10 BASE: All Qualified Respondents (n=1,210) Q715. How important would you say your sexual health is to your overall health? Extremely/Very Important In a relationship35%* Not in a relationship24% Experience desire more than weekly 43%* Experience desire weekly or less23% Satisfied with sex life38%* Not satisfied with sex life23% Excellent/Very good physical health34% Fair/Poor physical health29% Excellent/Very good mental health35%* Fair/Poor mental health25% Excellent/Very good body image38%* Fair/Poor body image28% Not Very/Not at All Important (NET) 19% Exp. Sexual Issue 18% No Sexual Issue 21% Extremely/Very Important (NET) 33% Exp. Sexual Issue 32% No Sexual Issue 36%

11. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Definition of Sexual Health. Women who have experienced a sexual issue are more likely to respond that nearly all factors are part of their definition of sexual health; however, they are less like to report that good physical or mental health are part of their definitions than those who have not experienced a sexual issue. 11 BASE: All Qualified Respondents (n=1,210) Q711. What does it mean to you to be sexually healthy? Please select all that apply. Women who believe their sexual health is important to their overall health and those who experience sexual desire more than once a week are more likely to report that all of these factors contribute to sexual health. Women in their 20s are more likely than older women to say: that not having any STDs (76%* vs. 63% of women in their 30s and 51% of women in their 40s) being able to talk with their partner about sex and sexuality (77%* vs. 69% of women in their 30s and 60% of women in their 40s) being able to have children (39%* vs. 19% of women in their 30s and 10% of women in their 40s)

12. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Healthy Frequency of Sexual Activity. Both women who have experienced a sexual health issue and those who have not respond similarly when asked how frequently women should engage in sexual activity, with three-quarters saying about once a week to a few times a week. 12 BASE: All Qualified Respondents (n=1,210) Q713. In general, how frequently do you believe women should engage in sexual activity to be considered sexually healthy? Among women who say that their sexual health is important to their overall health, 83% say women should have sex at least once a week to be sexually healthy (vs. 48% of those who say their sexual health is not important).

13. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Frequency of Sexual Activity. While three-quarters of women respond that they should engage in sexual activity weekly or more often to be considered sexually health, just over half of women do so this frequently. 13 BASE: All Qualified Respondents (n=1,210) Q713. In general, how frequently do you believe women should engage in sexual activity to be considered sexually healthy? Weekly or More (NET) Expectations76% Reality54% Among women currently in relationships 62% engage in sexual activity weekly or more often, compared to 78% of women in relationships who think that women should have sex weekly or more to be sexually healthy.

14. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Frequency of Desire. Regardless of whether they have experienced a sexual issue, women experience desire about equally often overall; however, when looking only at women in relationships, those who have not experienced an issue experience desire more often. 14 BASE: All Qualified Respondents (n=1,210) Q735. Over the last 4 weeks, how often did you feel sexual desire or interest? More than Once a Week (NET) In a relationship (NET)53%* Not married, in a relationship68%* Married47% Not in a relationship38% Satisfied with sex life59%* Not satisfied with sex life32% Satisfied with relationship55%* Not satisfied with relationship38% Sexual health important 59%* Sexual health not important18% More than once a week (NET) 51% Exp. Sexual Issue 50% No Sexual Issue 54% Among women in relationships, those who have experienced a sexual issue are significantly less likely to feel sexual desire more than once a week (49% vs. 64%* of those who have not experienced a sexual health issue).

15. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Frequency of Sexual Activity. Women who have experienced a sexual issue are much more likely than others to report that they engage in sexual activity too infrequently. 15 BASE: All Qualified Respondents (n=1,210) Q742. Do you feel that you engage in sexual activity too little, the right amount or too much? Engage in Too Little Sexual Activity In a relationship (NET)47% Not in a relationship61%* Satisfied with sex life33% Not satisfied with sex life88%* Satisfied with relationship43% Not satisfied with relationship70%* Feel desire more than weekly42% Feel desire weekly or less57%* Excellent/Very good physical health47% Fair/Poor physical health60%* Excellent/Very good mental health47% Fair/Poor mental health66%* Excellent/Very good body image42% Fair/Poor body image58%* Among women in relationships, those who have experienced a sexual issue are even more likely to report that they have sex too little (55%* vs. 22%).

16. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Reasons for Lack of Sexual Activity. Among women who have not experienced a sexual issue, not having a partner is by far the main reason for engaging in too little sex; among who have experienced a sexual issue, commonly cited reasons include being too tired, feeling insecure about their bodies and being too stressed. 16 BASE: Say they have too little sex (n=603) Q743. Why do you think you do not engage in sexual activity more frequently? Women who are satisfied with their relationships are more likely than those who are not to give reasons like being too tired (57%* vs. 36%) and being too busy with children (24%* vs. 7%). Those who are not satisfied with their relationships are more likely to give as their reasons relationship problems (78%* vs. 6%) and no longer being attracted to their partner (43% vs. 5%). Interestingly, those who are not satisfied with their relationships are significantly more likely than those who are to say that its painful for them to have sex (20%* vs. 2%). 20s 3% 30s 9%* 40s 5% Over one-fourth (27%) of women gave a possible symptom of sexual dysfunction as a reason for having too little sex (i.e. no desire, dont find sex satisfying, dont want to have sex more often; painful to have sex). Total Symptom Mentions 27% Experienced sexual issue 32%* Did not experience issue 3% Visited HCP about issue 46%* Did not visit HCP 24% Sexual health is important 24% Sexual health not important 38%*

17. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Satisfaction with Sex Life. Women who have not experienced a sexual health issue are much more likely to be satisfied with their sex lives. Being in a relationship is also very important to satisfaction with sex lives. 17 BASE: All Qualified Respondents (n=1,210) Q725. Overall, how satisfied are you with your sex life? Extremely/Very Satisfied In a relationship37%* Not in a relationship 9% Experience desire more than weekly 45%* Experience desire weekly or less18% Satisfied with relationship41%* Not satisfied with relationship 5% Sexual health important 36%* Sexual health not important13% Excellent/Very good physical health34%* Fair/Poor physical health20% Excellent/Very good mental health35%* Fair/Poor mental health10% Excellent/Very good body image41%* Fair/Poor body image21% Extremely/Very Satisfied (NET) 32% Exp. Sexual Issue 28% No Sexual Issue 41%* Not very/Not at all Satisfied (NET) 30% Exp. Sexual Issue 34%* No Sexual Issue 21%

18. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Issues That Affect Womens Sex Lives. While half of women who have not experienced a sexual issue say that nothing has negatively impacted their sex lives in the last year just one-fifth of those who have experienced a sexual issue report this. 18 BASE: All Qualified Respondents (n=1210) Q995 Which of the following, if any, do you think may have negatively affected your sex life in the last 12 months? Women who are not satisfied with their relationships or their sex lives are more likely to report that these factors have negatively affected their sex lives in the past year. 20s 9% 30s 15% 40s 18%* 20s 27%* 30s 22% 40s 16% 20s 36%* 30s 27% 40s 25% 20s 15%* 30s 5% 40s 1%

19. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Sexual Health Resources. Women turn to a variety of different resources for information on sexual health, with the internet and spouses/partners being the most common. 19 BASE: All Qualified Respondents (n=1,210) Q800. Which of the following resources have you turned to for information on sexual health issues? Has Health Insurance13%* No Insurance 5% College degree32%* No college degree 24% In a relationship27%* Not in a relationship18% Women who believe sexual health is important to their overall health, those who experience desire more frequently and those who have experienced a sexual issue are more likely to have turned to each of these sources.

20. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Experiences with Sexual Health Issues 20 ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E

21. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Comfort Discussing Sexual Health Issues. Women report the most comfort discussing sexual health issues with a spouse or romantic partner. 21 BASE: All Qualified Respondents (n=1210) Q830 How comfortable are you talking to each of the following people about sexual health issues? Women who say their body image is fair or poor are less likely to say they feel comfortable talking to any of these people, except for a close friend or a counselor/therapist. Women who believe sexual health is important to their overall health and those who experience desire more frequently are more likely to say they are comfortable talking to each of these people, with the exception of a sibling.

22. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Sexual Health Issues Experienced. Seven in ten women have ever experienced any of the sexual issues mentioned in the survey, with lack of desire being the most commonly reported symptom. 22 BASE: All Qualified Respondents (n=1210) Q905 Which of the following sexual health issues, if any, have you ever experienced? Q935 Have you experienced any of these in the past year? While nearly half of women who are not in relationships say they have never experienced any sexual issue (48%*), only about one-quarter (26%) of women who are in a relationship have never experienced any of these issues. 70% of women have ever experience at least one of these issues and 61% have experience at least one issue in the past year.

23. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Sexual Health Issues Experienced. While older women are more likely than younger women to have ever experienced lack of desire, younger women are more likely than older women to have experienced inability to have an orgasm, pain during intercourse or excessive desire. 23 BASE: All Qualified Respondents (n=1210) Q905 Which of the following sexual health issues, if any, have you ever experienced?

24. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Level of Concern About Sexual Health Issue Experienced. The majority of women who experienced a sexual issue were not very concerned about it, and less than one in ten say they were extremely concerned. 24 BASE: Experienced a Sexual Health Issue (n=850) Q945 How concerned were you when you first experienced …? Extremely/Very Concerned (NET): 22% Satisfied with sex life19% Not satisfied with sex life28%* Has too little sex27%* Has enough sex16% Visited HCP about issue43%* Did not visit HCP18%

25. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Sexual Health Issues Impact on Other Areas of Life. Fewer than half of women report that the sexual issues they experienced had a negative impact on any area except their sex lives, which just over half say was negatively affected. 25 BASE: Experienced a Sexual Health Issue (n=850) Q985 Now thinking in general about the sexual health issues you have experienced, such as …, what impact, if any, have they had on each of the following? Women who experienced a lack of desire to engage of sexual activity were more likely say this condition had a negative or very negative impact on their sex lives (66%* vs. 55% overall)

26. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E How Sexual Issues Negatively Impact Health. Among women who report that the sexual issues they experienced negatively impacted their health, they most commonly report that this impact came in the form of stress or depressed feelings. 26 BASE: Experienced a Sexual Health Issue, with Negative impact on Health (n=378) Q990 In what ways did the sexual health issues you experienced negatively impact your overall health?

27. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Steps Taken in Response to Sexual Health Issue. The most common responses when asked what steps women took when they experienced a sexual issue were that they didnt do anything, or that they spoke to their partner. Less than one-fifth visited a health care provider. 27 BASE: Experienced a Sexual Health Issue (n=850) Q950 What steps, if any, did you take when you experienced …? Please select all that apply. Women who visit their family doctor or general practitioner more than twice per year are more likely to have visited a health care provider about the sexual issue they experienced (30% vs. 18% overall). Please see next slide for profile of women who did not do anything.

28. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Reasons for Not Visiting a Health Care Provider. The most commonly cited reason for not visiting a health care provider about sexual health issues is that women did not think it was important enough to discuss with a doctor. 28 BASE: Experienced a Sexual Health Issue and did not visit Health Care Provider (n=731) Q955 Why didnt you visit a health care provider about …? Satisfied with sex life 9% Not satisfied with sex life25%* 20s 46%* 30s 38% 40s 28%

29. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E HCP Visits For Sexual Health Issue. About half of women who experienced a sexual issue and visited a health care provider did so in the past year. Seven in ten visited and OB/GYN while about one-third visited a primary care physician. 29 BASE: Experienced a Sexual Health Issue and Visited a Health Care Provider (n=119) Q960 When was the last time you visited a health care provider about…? Q965 What type of health care provider did you visit about …?

30. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Health Care Providers Approach to Treatment. Among women who visited a provider for a sexual health issue they experienced, less than half of the providers they visited asked questions, performed a routine exam, or provided any other advice or treatment. 30 BASE: Experienced a Sexual Health Issue and Visited Health Care Provider (n=119) Q970 What did the health care provider do to help address your …?

31. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Most Helpful Treatment Received. Among women who received some kind of treatment from the provider they visited, prescription medication was most commonly cited as most helpful in addressing the sexual issue they experienced. 31 BASE: Experienced a Sexual Health Issue and Visited Health Care Provider (n=105) Q975 Which one of these was most helpful in addressing your …?

32. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Medical Treatments Used. Women who experienced a sexual issue were most likely to use lubricants. Those who visited a health care provider were more likely to use all forms of treatments. 32 BASE: Experienced a Sexual Health Issue (n=850) Q1002 Which of following treatments have you taken or used for …?

33. ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E Thank you Questions? 33 ©2007, Harris Interactive Inc. H A R R I S I N T E R A C T I V E