Policy Research Working Paper; 11382, 2026. Washington, D.C.: World Bank Group.
Authors: Alexander Hamilton, Ford Hickson, Axel J Schmidt
Abstract
Being happy with one’s sex life is an important facet of sexual health. Several studies have found associations between sex life happiness and a range of individual (or proximate) and contextual (usually country-level) factors amongst men who have sex with men (MSM).
Using a novel dataset, the 2017 European Men-Who-Have-Sex-With-Men Internet Survey (EMIS-2017), we are able to simultaneously explore the association of both individual and contextual variables, and sex life happiness, and, ultimately, health. Understanding and quantifying this link is important for policymakers concerned with improving health outcomes in minority, and often marginalised, populations.
Recency of sex and/or being in a steady sexual relationship had the largest positive associations with higher self-reported sex life happiness. Being single had the largest negative association. Among individual-level factors, not having experienced homophobia and being out to a majority of one’s social network were most strongly associated with sex-life happiness. At the country-level, there is evidence that living in a country with a more authoritarian political regime is associated with less sex life happiness. Mediation analysis shows that authoritarian regimes are also indirectly negatively associated with sex life happiness via the likelihood of being open about one’s sexuality. Our study provides a strong basis for further research exploring the potentially complex associations between proximate and contextual variables in determining sex life happiness amongst MSM populations.