Sex under the age of 25: sexual health of young people in the Netherlands

“Sex under 25” is a participatory action research project. This implies collaboration with stakeholders from policy, practice and research in the field of (sexual) health promotion across the entire process, from research to action. The selection of topics in the questionnaire is partly the result of the stakeholders' preferences with regard to the research, which in turn is based on the information they need for their work. 

Participants were recruited both through randomly selected secondary schools and through a random sample drawn by Statistics Netherlands (CBS) from the municipal population registers. An invitation to fill out the online survey was sent to the home addresses of the latter group. The final sample consisted of 10,620 participants. Weighting techniques were applied to correct for selective non-response. The sample was thus representative of the Dutch youth population aged 13 to 24.

Young people start having sex at an older age compared with 2012 and 2017 (see Figure 1). All types of sex with a sexual partner show a rise in median sexual debut ages, except for masturbation. By 2023 half of young people had French kissed by the age of 16.4. Half of young people had engaged in manual sex by the age of 18.0, and half had engaged in oral sex by the age of 18.6. Half of young people had engaged in vaginal sex by the age of 18.7, compared with 18.0 in 2017 and 17.0 in 2012. The percentage of young people aged 13 to 18 who had been in love or had had a relationship also declined compared with 2017 and 2012.

Sexual pleasure is the most important reason for young people to have sex. Eight in ten young people enjoy sex very much and nine in ten young people felt pleasure during sex with their last sexual partner. Young people rate their sex life positively (7 out of 10). In this respect, boys and girls are very similar. 

However, when having sex with a sexual partner, girls experience significantly less sexual pleasure than boys. Two thirds (64 %) of the boys report that their first vaginal sex was pleasurable, compared to 28 % of the girls. This may have to do with the discomfort experienced during first vaginal sex, which was described as somewhat or very painful by three-quarters of the girls. Girls also experience less sexual pleasure than boys in later sexual experiences. Boys (85 %) are more likely than girls (75 %) to state that they enjoy sex very much. Additionally, more boys (85 %) than girls (49 %) usually or always had an orgasm with their last sex partner. Furthermore, girls (23 %) are more likely than boys (10 %) to have a sexual problem (e.g., experiencing distress over problems associated with desire, arousal or orgasm). 

One in thirty young people is trans or gender diverse: these young people indicate that their gender identity does not (fully and exclusively) match their assigned sex at birth or that they are questioning their gender identity. Compared with 2017 this group is slightly larger among birth-assigned girls. This increase is primarily due to a higher number of gender-diverse and questioning adolescents. One in nine boys and one in four girls are not exclusively sexually attracted to individuals with the opposite gender identity. This group has also increased slightly since 2017. 

Social acceptance of sexual and gender diversity has also increased among young people. In 2017 there was a significant decline in the number of young people who disapproved of expressions of homosexuality, and this trend is still ongoing. In 2012 half of the boys and a quarter of the girls disapproved of two boys kissing each other on the street, compared with a quarter of the boys (24 %) and one in eleven girls (9 %) in 2023. 

Although young people continue to associate sex with love and relationships, there appears to be a shift, mainly among girls. In 2012 a quarter of the girls (26 %) believed it was acceptable for two people to have sex without being in love. In 2017 nearly half (47 %) and by 2023 nearly two-thirds (62 %) believed this was acceptable. This is the first time that girls and boys have had similar perspectives on this. Furthermore, although the majority of young people report that they had a relationship with their first vaginal sex partner (62 %), this percentage has decreased since 2017 (70 %). Similarly, for an increasing number of young people, their most recent sexual partner was someone with whom they had sex more than once but did not have a relationship. Still, for two-thirds of young people, the last sexual partner was a steady partner. 

The online world also plays a role in the relational and sexual development of young people. For example, 18 % of young people met their last sexual partner online (e.g. through a dating app or social media). It is especially the oldest group who use dating apps. A third (35 %) of all 17-through 24-year-olds used a dating app in the past six months. In the same period 9% of boys and 8% of girls aged 17 and older had a date via a dating app and 5% of boys and 3 % of girls had sex with someone they met through a dating app. However, the use of dating apps has declined significantly since 2017 when nearly half of 17-through 24-year-olds used a dating app. Online media are also used to exchange nude pictures or sex videos (sexting). One in eight young people say they sent a nude or sex video of themselves to someone in the past six months. This tendency increased significantly in 2017 compared with 2012, but now appears to have stabilized. 

Use of the contraceptive pill has declined sharply among females with experience of vaginal sex, from 76 % in 2012 to 46 % in 2023 (see Figure 2). In contrast, IUD use has increased from 6 % in 2012 to 21 % in 2023. Not all girls who do not use contraceptive pills opt for another form of contraception. The percentage of girls not using contraception has increased from 9 % in 2012 to 20 % in 2023. More than half of the girls in this group stated that they do not wish to use hormones. However, this does not explain why IUD use has increased, as these are mainly hormonal IUDs, nor does it explain why condom use is also on the decline.

Despite declining pill use, the use of contraceptives when having vaginal sex is still high among young people in the Netherlands. Nine out of ten young people use contraception the first time they have vaginal sex and eight out of ten always used contraception with their last vaginal sex partner. Furthermore, the number of unintended and unwanted pregnancies among young people remains low. Eighteen out of 1,000 adolescents aged 16.5 and older have had an unintended pregnancy at some point in their lives. Fourteen in 1,000 boys and ten in 1,000 girls of this age have experienced an unwanted pregnancy. This number has not increased since 2017 and has even decreased slightly among girls.

The use of condoms has decreased substantially among young people in the Netherlands. In 2017 75 % of boys and 72 % of girls used a condom for their first vaginal sex. By 2023 this had decreased to 64 % and 69 %, respectively. Among young people who did not have a relationship with their most recent sexual partner, the group of boys who never used a condom increased from 25 % in 2012 to 40 % in 2023, while this group of girls increased from 36 % in 2012 to 46 % in 2023. The fact that these recent casual sexual partners were often someone with whom they had had sex more than once might play a role. There might be more trust in these kinds of sexual relationships than in one-night stands. One frequently cited reason for not using condoms is "we trust each other." 

In the past year 12 % of sexually experienced boys and 18 % of sexually experienced girls were tested for STIs and/or HIV. This number has not changed since 2012 and 2017. The percentage of positive STI and/or HIV tests also remained constant among young people aged 17 through 24. Two percent of boys and 4 % of girls of this age tested positive in the past year. Most young people go to their general practitioner (GP) or the Public Health Service (PHS) for an STI test. Girls choose their GP slightly more often (47 %) than boys (39 %), while boys choose the PHS more often (42 %) than girls (31 %). 

Two in three girls (66 %) and one in three to four boys (29 %) have experienced sexual victimization, ranging from unwanted sexual comments and touching to all forms of sex against their will. Between 2017 and 2023 there was an increase in the number of young people reporting that they have been forced into sex or have experienced sex against their will (see Figure 3). Among girls, the percentage who had been forced to perform sexual activities against their will increased from 12 % in 2017 to 20 % in 2023. In 2023 5 % of boys and 22 % of girls report having experienced sexual violence, which includes forced sexual activities, and/or manual, oral, vaginal, or anal sex against their will. It is possible that these various types of sexual victimization are more prevalent. However, this trend could possibly be linked to greater media coverage of sexual harassment and sexual violence and greater public attention to the topic. As more young people become aware of sexual harassment and violations, they are more likely to report it in a questionnaire.

Only 6 % of young people believe they have had sex with someone without having been certain that the other person also wanted to have sex. The majority of young people state that they always check whether the other person wants sex, especially with new partners. Ten percent of young people report they do not always check this, primarily because they assume they know without checking. This seems to contradict the fact that many young people report having had sex against their will. Moreover, some young people may not always notice that the other person does not want to have sex. Over half (52 %) of young people who have experienced sexual violence report that they did not make it clear that it happened against their will. There were several reasons for this: some people did not realize (yet) that they did not want to have sex, some people were afraid, and some froze. It is important to note that although these sexual experiences did not involve a clear refusal, they also did not involve an explicit consent.

Although practically everyone receives some information at school about sexuality, this is very limited according to young people. It focuses mostly on contraception, reproduction and STI/HIV. Nevertheless, only a minority of young people say they received enough information on these three topics. The vast majority of young people report receiving little to no information on sexual violence, sexual pleasure, and sex in the media. Young people rated sexuality education in school moderately (5.6 out of 10), which was slightly lower than in 2017. Girls, LGBTQ + youth, and older adolescents gave even lower ratings to the information they received in school. 

Young people want good sex education. Those who rated sex education poorly were asked for the reason why. Two-thirds of these young people indicated that there were too few lessons, while half of them indicated that they did not receive the information they wanted. Over 50 % of young people reported that they sometimes have questions regarding sexuality. Three-quarters of young people use the internet to find the answers to their questions. More than half ask their friends. It is uncertain to what extent the information they obtain online or from friends is reliable. 

“Sex under the age of 25” 2023 shows that young people continue to do well in several areas of sexual health. Young people are taking their time before starting to have sexual experiences. They enjoy sex and protect themselves well against pregnancy. There also seems to be more room for sexual and gender diversity, and diversity in sexual relationships. 

Other outcomes are concerning. Sexual violence is still too prevalent and young people appear to be insufficiently able to assess and express sexual consent correctly. There is a considerable gap in orgasms between boys and girls. Issues such as pain during sex and limited sexual pleasure are common among girls during their sexual debut and persist in their later sexual experiences. Furthermore, contraception and condom use are on the decline. Young people generally give sex education a poor rating. These concerning outcomes show that there is a greater need for investment in prevention and continuous sex education with a more positive and gender-sensitive approach towards sexuality and sexual pleasure. These insights of “Sex under the age of 25” provide input for interventions, policy and further research, aiming to further improve the sexual health of future generations.

This research was conducted by Rutgers and Soa Aids Nederland in collaboration with the Dutch National Institute for Public Health and the Environment (RIVM), Statistics Netherlands (CBS) and the municipal health organisations (GGD). The study was funded by the Dutch Ministry of Health (VWS) and the RIVM.