Dyspareunia and its consequences among female young adults in Switzerland – a cross-sectional study

Dyspareunia and its consequences among female young adults in Switzerland – a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Dyspareunia and its consequences among female young adults in Switzerland – a cross-sectional study Samia El-Hadad, Moira Rudolphi Bsc, Angela Niggli, Brigitte Leeners This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6306648/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background/Objective(s)/Introduction: Dyspareunia is known to be highly prevalent, but knowledge about prevalences, consequences and etiology among young female adults (FYA) remains. This study aims to examine prevalences and key factors associated with dyspareunia in sexually active FYAs. Patients/Materials and Methods: We systemically evaluated data from a large representative sample of FYAs in Switzerland who participated in an online self-administrated questionnaire. Participants reported on behavioral, psychosocial factors as well as on sexual history and a structured comparison between FYAs with and without dyspareunia was performed. To assess sexual functioning, we used the Female Sexual Function Index-6. Results: We evaluated 2718 questionnaires, of which 2059 provided an answer on having dyspareunia or not. We found a prevalence of 35.1% for dyspareunia among FYAs. Cases who reported a lower number of lifetime sexual partners, who perceived the quality of their first sexual intercourse as poor, who accepted unwanted sexual encounters and/ or had a history of STDs suffered significantly more often from dyspareunia. After conducting multivariate regression analysis, both parents being non-Swiss and poor mental health remained statistically significant predictors for dyspareunia, with an almost 20% increased risk. Having a higher number of lifetime partners was associated with a 12% reduced likelihood to experience dyspareunia (p-value = 0.005; OR 0.88). Sexual dysfunction was found to be significantly more frequent in FYAs with dyspareunia (p-value = 0.001). Conclusions: Dyspareunia is highly prevalent among FYAs leading to significantly reduced sexual functioning. Further longitudinal research is essential to gain a deeper understanding of the causative influence of the various identified risk factors. dyspareunia pelvic pain female sexual dysfunction young adult Introduction With a global prevalence of 8% − 22% in adult women and an estimated life-time risk of 30%, dyspareunia, i.e. recurrent pain induced by vaginal sexual intercourse, is a burdensome and clinically highly relevant condition(Sorensen et al., 2018 ). The consequences of chronic dyspareunia extend beyond physical discomfort and sexual health, where dyspareunia may induce a variety of secondary sexual disorders such as arousal disorders, loss of sexual desire and orgasmic dysfunction(Hämmerli et al., 2020 ; Marques Cerentini et al., 2023a ; Sorensen et al., 2018 ). Women affected by dyspareunia face a diminished overall quality of life, reduced mental health including feelings of isolation, reduced self-esteem, negative body image perceptions, an elevated risk of relationship difficulties(De Graaff et al., 2016 ; Hill & Taylor, 2021 ; Schneider et al., 2020 ). Although quality of sex life in the context of dyspareunia has been intensively investigated in adult women(Mohammadzadeh et al., 2022 ), women in early adulthood have so far received only little attention. The etiology of dyspareunia, is very divers, not yet fully understood and frequently remains unexplained(Hill & Taylor, 2021 ). Gynecological factors contributing to dyspareunia encompass vulva diseases(Edwards, 2015 ), pelvic trauma associated with childbirth(McDonald et al., 2015 ), endometriosis(Schneider et al., 2020 ; Yong et al., 2017 ), consequences of gynecological surgery(Streicher, 2023 ) or pelvic radiation(Streicher, 2023 ), pelvic inflammatory disease(Oshinowo et al., 2016 ), uterine myoma(Ferrero et al., 2006 ), retroversion of the uterus(Fauconnier et al., 2006 ), pelvic varices(Neĭmark et al., 2007 ), lichen sclerosus and other vulva diseases(Gross & Brubaker, 2022 ; Pope et al., 2022 ) for example as a consequence of contraception or menopause(Hill & Taylor, 2021 ). Additionally, recurrent vaginal or vulvar infections may be involved(Hill & Taylor, 2021 ). Non-gynecological causes of dyspareunia include fibromyalgia, painful bladder syndrome, inflammatory bowel disease, and musculoskeletal pain(Gross & Brubaker, 2022 ; Pope et al., 2022 ). Furthermore, multiple psychological aspects such as relational factors, anxiety, depression, and pain catastrophizing, and of course sexual behavior may contribute to painful sexual intercourse(Leeners et al., 2015a ; Meana & Binik, 2022 ). The very few available studies support an even higher prevalence of dyspareunia in young women than in elder women that has been reported to range from 20–60%(Edwards, 2015 ; Landry & Bergeron, 2009a ). This is quite astonishing as many of the known etiological factors are more frequent in adult women, however, available data stem from selected subgroups so that we lack representative data. Despite its considerable prevalence and the significant impact known from adult women, causes and consequences of dyspareunia in young adult women are currently underinvestigated. As sexuality is usually consolidating in this age group and first experiences strongly influence longtime sexual health and satisfaction(Long & Damle, 2024 ), it is particularly important to close the current knowledge gap and improve basic conditions for better counselling. Today women are hesitant to consult a health professional, health professionals do not actively address dyspareunia and there is no standard approach for diagnosis and treatment so that many women remain undiagnosed and untreated(Maurice & Bowman, 1999 ). The situation is likely to be even worse in young females, where sexuality is still developing and open communication with health professionals, friends, family, or a partner is often experienced as challenging and uncomfortable but would be highly beneficial for a healthy development of sexuality. In addition to improved counselling, early identification of dyspareunia in adolescents might help to counteract chronification as pain processing may be modified through severe pain experiences and no longer be reversible thereafter(Landry & Bergeron, 2009b ). Aims Therefore, this study aims (i) to assess the prevalence of dyspareunia among a representative group of female young adults (FYA) and (ii) to identify differences in the biomedical, behavioral, and psychosocial profile of sexually active FYA affected by dyspareunia compared to sexually active pain-free FYA. Furthermore, it is our goal to (iii) evaluate potential effects of early dyspareunia on later sexual function and satisfaction. Methods Study design: The Swiss national survey on youth sexual behaviors was conducted as a representative, cross-sectional study of young adults with a mean age of 26 years in 2017. The initial representative sample (gender; language: French, Italian or German; canton of residence) of the 24–28 years old population living in Switzerland was provided by the Swiss Federal Office of Statistics. Study participants were invited with a postal information letter together with a unique login code to participate in an online self-administrated questionnaire. The questionnaire was developed specifically for this study and available in German, French and Italian. The electronic version of the questionnaire allowed to capture how much time the respondents spent on answering the questionnaire and whether they completed it continuously or provided their answers in several sessions with pauses in-between. For each section of the questionnaire differentiated analysis of the number of questions answered were realized. Only respondents who had answered at least 80% of the relevant questions were considered in our present analysis. The questionnaire used internationally validated previously used questionnaires wherever possible, so that we refrained from further tests to reevaluate reliability and validity. The design of the present study was based on a previous survey conducted in 1996 (Ottesen et al., 2002 ) , (Leeners et al., 2018 ). A complete and detailed version of the study design, as well as a French and English version of the questionnaire as an EXCEL file are available in the Supplementary materials. The survey collected sociodemographic, sexual health and behavior data using a life history calendar (LHC) approach. The LHC is a data collection approach that facilitates recall of past events by using the individual’s own past experiences as cues for remembering(Martyn et al., 2013 ; Morselli et al., 2016 ). The manuscript was drafted following STROBE criteria(von Elm et al., 2008 ). In- and exclusion criteria: For the present evaluation young women without gender dysphoria describing themselves as heterosexually oriented were evaluated. For sexual orientation, we used a multidimensional approach including sexual orientation identity, sexual attraction, and sex of sexual partner(s)(Von Rosen et al., 2017 ; Waltermaurer et al., 2013 ). Furthermore, we excluded participants who had never had sexual intercourse as dyspareunia can per definition only be diagnosed in the context of intercourse. The categorization between young women experiencing dyspareunia and those with pain-free sexual intercourse was made based on the question: “Are you regularly experiencing pain during vaginal penetration?” with the option to answer “Yes” or “No”. We assessed occurrence of dyspareunia as experienced by the study participant and investigated the degree of sexual satisfaction by using the Female Sexual Function Index-6 (FSFI-6), a 6-item, brief, and self-administered instrument derived from the original 19-item FSFI that measures female sexual function. It comprises the six domains desire, arousal, lubrication, orgasm, satisfaction, and pain. Desire and satisfaction items are rated on a 5-point Likert scale, ranging from 1 to 5, and the other items are rated on a 6-point Likert scale, ranging from 0 to 5. Total scores may vary between 2 and 30, with lower scores indicating worse sexual functioning. We calculated individual domain scores and an overall score (sum of domain scores) of the FSFI (Table 4 ). Women who scored < 19 were classified as having Female Sexual Dysfunction (FSD)(Isidori et al., 2010 ). Sociodemographic and personal characteristics included age, origin of parents, place of residence (urban, rural) and attained education level. We included parental origin as a variable because cultural attitudes and sexuality seem to be strongly linked(Bober & Chevalier, 2021 ; Espinosa-Hernández et al., 2020 ). To assess general health and health-conscious behavior we collected information on mental health and on the presence of chronic disease. We evaluated the association between dyspareunia and general as well as mental health status. Depression and anxiety were assessed with the mental health inventory (MHI-5) using 5 items referring to the last 4 weeks (Berwick et al., 1991 ): “How much of the time during the past 4 weeks have you… (1) been a very nervous person? (2) felt so down in the dumps that nothing could cheer you up? (3) felt calm and peaceful? (4) felt downhearted and blue? (5) been a happy person?” The mental health score ranges from 0 to 100 with higher values representing better health. As recommended by previous authors, we used a cut-off of ≤ 52 to differentiate between reduced and normal mental health(Bayley et al., 2009 ; Cameron et al., 2012 ). Age at menarche and a history of sexually transmitted diseases (STDs) served to evaluate gynecological health status. We investigated type of present relationship, own age at the first steady partnership and sexual risk behavior. Frequently or sometimes having sex after consummation of drugs or alcohol, without contraception as well as an age below 14 years at the time of the 1st sexual intercourse and having more than 10 lifetime sex partners were classified as sexual risk behavior. To assess experiences at 1st sexual intercourse we used modified questions from the National Surveys of Sexual Attitudes and Lifestyles (NATSAL), the largest survey of sexual behavior in the world(K. R. Mitchell et al., 2012 ). We assessed experiences of undesired, but voluntary sexual experiences by asking: “In the course of your life, have any of your sexual contacts or relationships been unwanted?” and “Have you ever accepted sex you didn't really want to have?”. The question: “Have you ever been sexually assaulted or abused? (Sexual assault or abuse is when someone forces you)” was used to assess the history of sexual abuse. Ethics: All data were entered with an anonymous code into an access database specifically developed for the study. The study protocol was submitted to the Ethics commission of the canton of Vaud (CER-VD) and granted exemption, as it did not need to be evaluated according to Swiss law. It was realized in accordance with the Declaration of Helsinki. Statistics: We performed bivariate analysis to compare the characteristics of young women presenting with and without dyspareunia. Chi-Square (Χ²) test was used to assess this difference with respect to categorical variables and Mann-Whitey-U-test was applied to evaluate the equality of the group means over continuous variables. A p-value of less than 0.05 was considered statistically significant. We presented descriptive statistics to summarize results. Subsequently, we conducted multivariate logistic regression analysis to evaluate factors associated with the occurrence of dyspareunia and calculated p-values, adjusted p-values, as well as adjusted odds ratios (OR). Statistical analysis was performed using the R-Software, Version 4.1.2. Results The final sample included 2789 female participants (response rate 15.1%). After excluding participants who reported gender dysphoria, identified as homosexually oriented, and/or had not engaged in vaginal intercourse yet, 2718 FYA were available for statistical analysis. A total of 2059 participants reported whether they suffer from dyspareunia or not, while the remaining 659 participants answered: “I don’t want to answer” or “I don’t know” and were excluded from the analysis. Altogether, of the 2789 FYA who provided an answer 723 (35.1%) reported experiencing dyspareunia. Table 1 displays sociodemographic data for FYA with and without dyspareunia. Both parents being non-Swiss-born was positively associated with the occurrence of dyspareunia while educational status and residential area showed no association with dyspareunia. Table 1 Sociodemographic characteristics among FYA with dyspareunia FYA with dyspareunia N = 723 FYA without dyspareunia N = 1372 p-value Age (mean ± SD in years)* 26.35 ± 0.95 26.30 ± 0.96 0.163 Parents born in CH (N/%)** < 0.001 Both Swiss-born 459 (63.49%) 989 (72.08) One Swiss-born 113 (15.63%) 205 (14.94) Both non-Swiss-born 151 (20.89%) 178 (12.97) Highest education level (N/%)** 0.537 Mandatory school 7 (0.97%) 10 (0.73%) Vocational training, apprenticeship Professional maturity 185 (25.59%) 388 (28.28%) High School Diploma 78 (10.79%) 146 (10.64%) University 430 (59.47%) 784 (57.14%) Residence area, urban vs rural (N/%)** 0.769 1 Urban 319 (44.12%) 616 (44.90%) 2 Rural 404 (55.88%) 756 (55.10%) SD: Standard deviation; CH: Switzerland; N: Numbers Metric variables are marked with * and were evaluated using the Mann-Whitney-U-test Categorical variables are marked with ** and were evaluated using the chi-square-test p-values are presented as adjusted p-values; significant p-values are marked in bold 1 Urban: city, suburb of a city (more than 10,000 inhabitants), 2 Rural: mountains, countryside, village (less than 10,000 inhabitants) Table 2 presents general and sexual health information. FYA with dyspareunia had a lower mental health score (65.70, SD = 14.40 vs. 70.62, SD 13.62, p < 0.001). Among FYA with dyspareunia the number of those suffering from a chronic disease was slightly higher compared to those participants having no dyspareunia (17.70% vs 14.65%, p = 0.036). In addition, FYA with dyspareunia were more likely to report a previous diagnosis of an STD (33.75% vs. 30.54%, p = 0.037). Table 2 General and genital health data among FYA with Dyspareunia FYA with dyspareunia N = 723 FYA without dyspareunia N = 1372 p-value Mental health sum score (mean ± SD)* 65.70 ± 14.4 70.62 ± 13.62 < 0.001 Chronic disease (N/%)** 128 (17.70%) 201 (14.65%) 0.036 Menarche (mean ± SD in years)* 13.60 ± 2.48 13.58 ± 2.50 0.910 STDs diagnosed ever (N/%) ** 244 (33.75%) 419 (30.54%) 0.037 SD: Standard deviation; N: Numbers Metric variables are marked with * and were evaluated using the Mann-Whitney-U-test Categorical variables are marked with ** and were evaluated using the chi-square-test p-values are presented as adjusted p-values; significant p-values are marked in bold Table 3 summarizes information on the history of partnerships and sexuality. FYA with a higher age at their first steady partnership, first sexual intercourse, and a lower number of overall lifetime sex partners were more likely to report dyspareunia. However, although associations between those variables and dyspareunia were statistically significant on a bivariate level, numbers were very similar, and consequently clinical relevance needs to be interpreted with caution. Age and type of relationship during the first sexual intercourse, feelings of regret about it, and sexual risk behaviors such as intercourse without contraception or while intoxicated/drugged showed no correlation with dyspareunia. FYA with dyspareunia experienced their first sexual intercourse as less pleasant (20.61% vs. 30.32%, p-value < 0.001) and remembered it more frequently as disagreeable or very unpleasant (34.02% vs. 24.13%, p-value < 0.001). Negative sexual experiences, such as accepting sex without really wanting it, were significantly associated with dyspareunia, while the prevalence of sexual assault did not differ between the groups. Communicating with parents about sexuality was less common among FYA with dyspareunia (25.86% vs. 33.09%; p-value = 0.020). Table 3 History of partnership, sexuality and sexual behavior among FYA with dyspareunia FYA with Dyspareunia N = 723 FYA without dyspareunia N = 1372 p-value Age at 1st steady partnership (mean ± SD)* 17.50 ± 2.82 17.15 ± 2.84 0.007 Number lifetime sex partners (N/%)** 0.001 0 0 0 1 139 (19.23%) 229 (16.69%) 2–3 181 (25.03%) 291 (21.21%) 4–7 190 (26.28%) 352 (25.66%) 8–10 77 (10.65%) 178 (12.97%) > 10 136 (18.81%) 322 (23.47%) Age 1st sexual intercourse (mean ± SD)* 17.63 ± 2.82 17.22 ± 2.59 0.004 1st sexual intercourse within a stable relationship? (N/%)** 535 (74.00%) 1033 (75.29%) 0.610 Reflections on 1st sexual intercourse with vaginal penetration (N/%)** 0.634 I shouldn't have done it 68 (9.41%) 127 (9.26%) I should have waited longer 78 (10.79%) 144 (10.50%) I should not have waited so long 16 (2.21%) 29 (2.11%) It was the right time 491(67.91%) 961 (70.04%) Perception of 1st sexual intercourse (N/%)** < 0.001 Very nice/ Pleasant 149 (20.61%) 416 (30.32%) Neither pleasant nor unpleasant 302 (41.77%) 570 (41.55%) Disagreeable/ Very unpleasant 246 (34.02%) 331 (24.13%) Main person to discuss sexuality (N/%)** 0.020 Mother/Father 187 (25.86%) 454 (33.09%) School 131 (18.12%) 204 (14.87%) Friends/ other family members 290 (40.11%) 534 (38.92%) None 19 (2.63%) 25 (1.82%) Internet 41 (5.67%) 73 (5.32%) Ever engaging in sex not really wanted (N/%)** < 0.001 No 271 (37.48%) 641 (46.72%) Yes, one time 184 (25.45%) 309 (22.52%) Yes, multiple times 264 (36.51%) 418 (30.47%) Ever having been sexually assaulted or abused (N/%)** 98 (13.55%) 199 (14.50%) 0.577 Sexual intercourse while intoxicated or high on drugs (N/%)** 0.570 Often 17 (2.35%) 36 (2.62%) Sometimes/Rarely 319 (44.12%) 618 (49.42%) Never 387 (53.53%) 718 (52.33%) Sexual intercourse without contra-ception (N/%)** 0.777 Often 44 (6.09%) 69 (5.03%) Sometimes/Rarely 357 (49.38%) 713 (51.97%) Never 322 (44.54%) 590 (43.00%) SD: Standard deviation; N:Numbers Metric variables are marked with * and were evaluated using the Mann-Whitney-U-test Categorical variables are marked with ** and were evaluated using the chi-square-test p-values are presented as adjusted p-values; significant p-values are marked in bold Table 4 presents FSFI-scores among participants. FYA dyspareunia reported lower scores in all six domains and lower total FSFI-6 sum scores compared to FYA without dyspareunia. A total of 124 (17.15%) of FYA with dyspareunia reached FSFI-6 sum scores < 19, indicating sexual dysfunction, compared to 48 (3.5%) in the group without dyspareunia. Table 4 Sexual satisfaction and FSFI-6-item score among FYA with and without dyspareunia Score-range FYA with dyspareunia N = 723 FYA without dyspareunia N = 1372 p-value Desire (mean ± SD) 1–5 3.3 ± 0.91 3.60 ± 0.90 < 0.001 Arousal (mean ± SD) 0–5 3.73 ± 0.87 4.05 ± 0.84 < 0.001 Lubrification (mean ± SD) 0–5 3.93 ± 1.27 4.56 ± 0.93 < 0.001 Orgasm (mean ± SD) 0–5 3.60 ± 1.39 3.86 ± 1.33 < 0.001 Satisfaction (mean ± SD) 0–5 4.05 ± 1.03 4.38 ± 0.93 < 0.001 Pain (mean ± SD) 0–5 3.41 ± 0.83 5.00 ± 0.00 < 0.001 Total FSFI-6-item Score (mean ± SD) 22.04 ± 4.04 25.46 ± 3.29 < 0.001 FSFI-6 sum score < 19 1 (N/%) 124 (17.15%) 48 (3.5%) < 0.001 1 A score < 19 represents sexual dysfunction All subscores, as well as the total FSFI-scores were evaluated using the Mann-Whitney-U-test p-values are presented as adjusted p-values; significant p-values are marked in bold After conducting multivariate regression analysis (Table 5 ), both parents being non-Swiss remained a statistically significant predictor for dyspareunia (p-value < 0.001; OR 1.64 to suffer from dyspareunia if both parents are non-Swiss compared to Swiss parents). A higher mental health score correlated negatively with the occurrence of dyspareunia, e.g. a drop of 5 points in the average mental health score of FYA showed an increased likelihood of suffering from dyspareunia (p-value < 0.001; OR 1.98 for FYA with average mental health scores of 65.70 ± 14.4 compared to those with 70.62 ± 13.62). A diagnosis of STDs, a negative experience at the first sexual intercourse, and accepting unwanted sex also remained significant correlates of dyspareunia. Increasing numbers of lifetime partners significantly correlated with a decreased likelihood for FYA to experience dyspareunia (2–3 lifetime partners p-value = 0.28, OR 1.65; 4–7 lifetime partners p-value = 0.02, OR 1.65; 8–10 lifetime partners p-value 10 lifetime partners p-value < 0.001, OR 2.44). Communicating about sexuality with their parents in comparison to friends showed a decreased risk for suffering from dyspareunia (p-value = 0.04, OR 0.76). Table 5 Multivariate logistic regression evaluating the association between different socio-epidemiologi-cal, as well as general, and sexual health factors and the occurrence of dyspareunia in FYA Estimate SE p-value OR 95% CI Swiss parents Both non-Swiss-born Reference category One Swiss-born 0.27 0.19 0.17 1.31 -0.19–0.61 Both Swiss-born 0.49 0.15 < 0.001 1.64 0.13–0.76 Chronic disease No Reference category Yes, non-limiting -0.26 0.16 0.10 0.77 -0.542 -0.09 Yes, limiting 0.57 0.35 0.10 1.78 -0.19–1.18 Educational level Obligatory school Reference category Apprenticeship/Baccalaureate -1.08 0.81 0.18 0.34 -2.58–0.59 University of Applied Sciences -1.05 0.82 0.20 0.35 -2.69–0.52 University -1.22 0.81 0.13 0.29 -2.79–0.36 Residence area 1 Urban Reference category 2 Rural 0.10 0.12 0.39 1.11 -0.17–0.30 Age at menarche 0.01 0.02 0.62 1.01 -0.03–0.06 Mental health score -0.02 0.00 < 0.001 1.98 -0.03 - -0.02 STDs diagnosed ever No Reference category Yes -0.24 0.12 0.04 0.78 -0.47–0.02 Age at first steady partnership -0.02 0.03 0.46 0.98 -0.07–0.04 Number of lifetime sex partners 1 Reference category 2–3 0.19 0.18 0.28 1.22 -0.16–0.55 4–7 0.50 0.22 0.02 1.65 0.07–0.93 8–10 0.87 0.27 10 0.89 0.26 < 0.001 2.44 0.37–1.41 Age at first sexual intercourse -0.02 0.03 0.51 0.98 -0.08–0.04 Type of relationship at first sexual intercourse Stable Reference category Occasional/flirt -0.14 0.15 0.38 0.87 -0.51–0.13 Regretting first sexual intercourse Not right moment Reference category Right moment -0.27 0.15 0.08 0.76 -0.58–0.03 I don’t know -0.19 0.23 0.42 0.83 -0.65–0.27 Quality first sexual Intercourse Good/very good Reference category Neutral -0.37 0.14 0.01 0.69 -0.66 - -0.10 Bad/very bad -0.69 0.16 < 0.001 0.50 -1.06 - -0.43 Communication about sexuality Parents Reference category School -0.21 0.17 0.20 0.81 -0.54–0.11 Friends -0.27 0.13 0.04 0.76 -0.53 - -0.02 None 0.09 0.41 0.83 1.09 -0.72–0.89 Internet -0.20 0.24 0.41 0.82 -0.66–0.27 Sex without wanting it Never Reference category One time -0.16 0.15 0.28 0.85 -0.44–0.13 Multiple times -0.32 0.13 < 0.001 0.72 -0.58 - -0.07 Sexual abuse No Reference category Yes 0.26 0.17 0.12 1.30 -0.07–0.59 Sex without contraception Often Reference category Sometimes/rarely 0.28 0.27 0.29 1.33 -0.25–0.81 Never 0.56 0.31 0.07 1.75 -0.05–1.17 Sex while on alcohol/drugs Often Reference category Sometimes/rarely 0.00 0.37 0.99 1.00 -0.73–0.72 Never -0.07 0.38 0.86 0.94 -0.81–0.68 OR: Odds ratio; SE: Standard error; 95% CI: 95% Confidence interval As reference category for performing multivariate logistic regression analysis, we used the group with dyspareunia Significant p-values are marked in bold 1 Urban: city, suburb of a city (more than 10,000 inhabitants), 2 Rural: mountains, countryside, village (less than 10,000 inhabitants) Discussion In this large national sample, more than one in four FYA reported dyspareunia. The condition was particularly prevalent among FYA with poor first sexual experiences, a history of unwanted sexual encounters, a history of STDs, fewer lifetime sexual partners, lower mental health scores, and non-Swiss parentage. As expected, FYA with dyspareunia also exhibited higher rates of sexual dysfunction and reduced sexual satisfaction. Our study found a 35.1% prevalence of dyspareunia in FYA, which is far higher than the 8–21% reported in adults(Alimi et al., 2018a ; Sorensen et al., 2018 ). This aligns with other studies highlighting a particularly high risk in younger women(Fergus et al., 2020 ; K. Mitchell et al., 2017 ). In sexually active girls with an average age of 19 years painful intercourse has been reported by one out of three girls(Berglund et al., 2002 ) and out of 300 13–21-year-old young women recruited in a youth center in Sweden even 49% reported dyspareunia(Elmerstig et al., 2009 ). These higher rates in comparison to our study may have to be attributed to the lower age of the participants which may be related to a higher percentage of participants engaging in intercourse not only or not at all motivated by desire. Recruitment of different study groups and differences in the definition of dyspareunia further hamper comparison of results. However, all studies confirm high rates of painful intercourse among FYA, which need to be addressed to improve actual sexual satisfaction and reduce the risk for an unfavorable development of future sexual health. FYA who had their first steady partnership and sexual intercourse at an older age were more likely to report dyspareunia, consistent with other studies(Donders et al., 2011 ). Despite statistically significant differences, absolute numbers were very similar, so that these results should be interpreted with caution. Expectations and tension surrounding first sexual intercourse may vary based on prior discussions, and age-related fibrosis of the posterior hymen might increase dyspareunia risk(Donders et al., 2011 ). Women who experience pain from genital contact may avoid sexual activities, potentially explaining why those with dyspareunia initiated sexual relations later and had fewer lifetime partners(Meana & Binik, 2022 ; K. Mitchell et al., 2017 ). However, distinguishing between causes and symptoms remains challenging. Our findings indicate that the quality of the first sexual intercourse significantly correlates with the occurrence of dyspareunia. Multivariate logistic regression showed that a negative first sexual experience is associated with a higher risk of suffering from dyspareunia (OR 1.25). While most studies support the formative impact of early sexual experiences on young women(Cacciatore et al., 2019 ; Van De Bongardt et al., 2015 ), some contradict this(Elmerstig et al., 2009 ). The link between sexual experiences and dyspareunia is further reinforced by its higher prevalence among participants who engaged in sexual encounters voluntarily but without genuine desire. Reported reasons included lack of self-confidence, inexperience, aiming to maintain a relationship, love, substance influence, fear of saying no, or own ambiguous behavior. Whereas some studies found a correlation between sexual abuse experiences and dyspareunia (Leclerc et al., 2010 ; Tetik & Yalçınkaya Alkar, 2021 ), other findings including our own results did not confirm a direct association(Santerre-Baillargeon et al., 2017 ). We found a significant correlation between dyspareunia and undesired, yet voluntary, sex, with no direct link to sexual abuse. This supports the mixed findings in previous research. Relationship dynamics, such as partner familiarity and intercourse frequency, likely play a role and should be explored further, including the influence of attachment anxiety. Although we did not find a significant link between dyspareunia and sexual abuse, poor mental health—often a result of abuse—is associated with an increased risk of dyspareunia. In agreement with other studies we found a 20% higher frequency of reduced mental health in FYA with dyspareunia(Basson & Weijmar Schultz, 2007; Wylie et al., 2004 ). In adult women, most studies show higher depression scores in women with dyspareunia(Jackowich et al., 2021 ; Leeners et al., 2015b ). Mental health disorders can both cause and result from dyspareunia, so addressing one may improve the other(Davis et al., 2013 ). Early treatment of dyspareunia could enhance both sexual and mental health, and FYA with depression and anxiety may benefit from targeted sexual counseling. FYA with dyspareunia were more likely to report previous STDs, which is in line with the known role of genital and vaginal infections—especially when recurrent or inadequately treated—as causes of dyspareunia(Alimi et al., 2018b ; Edgardh & Abdelnoor, 2003 ). Central sensitization is one of the suspected underlying mechanisms(Sadownik, 2014 ). Increased STD exposure may indicate sexual encounters not driven by self-confident desire, augmenting the risk of tension-related dyspareunia. Additionally, some FYA may endure painful sex to protect their self-image(Elmerstig et al., 2008 ). Psychological and sexual counseling is recommended to boost self-confidence and support healthy sexual relationships with a reduced risk of dyspareunia. Our findings align with previous research showing a correlation between chronic (gynecological) diseases and dyspareunia(Shi et al., 2022 ). Conditions like endometriosis are strongly associated with painful sexual activities(K. Mitchell et al., 2017 ). However, we lacked specific data on participants' chronic diseases, necessitating future research to explore the underlying mechanisms, such as whether differences in pain perception contribute to various chronic pain disorders or if one pain disease increases the risk for others. We also found a significant link between dyspareunia and having non-Swiss parents. Given that the effective difference in this variable is relatively small and the inherent variability of non-Swiss population, it is likely that we have captured an effect that is more attributable to culturally influenced attitudes and concepts regarding sexuality. Attitudes and societal views on intimacy and sexual satisfaction likely contribute to dyspareunia, supported by geographical and ethnic variations in prevalence(Harlow et al., 2014 ). These differences may indicate variations in tension-related attitudes towards sexuality, but also in discomfort interpretation and symptom reporting. Dyspareunia and quality of sexuality Our study found that FSFI-6 scores were, on average, 3 points lower in FYA with dyspareunia, consistent with previous research, showing an increased risk of secondary sexual dysfunction in women with dyspareunia(De Graaff et al., 2016 ; Sorensen et al., 2018 ). Altogether, 17% of FYA with dyspareunia experienced secondary sexual dysfunction compared to 3.5% without dyspareunia, underscoring the importance of evaluating dyspareunia in the context of other sexual complaints. In a Brazilian student sample the prevalence of female sexual dysfunction in women with dyspareunia was 23% (Marques Cerentini et al., 2023b ), but a direct comparison with our findings is not possible because the study population was smaller evaluating data from 187 students. In another study, American students reported frequent pain during in 19% and occasional pain in 24% during sexual intercourse(Azim et al., 2021 ). Dyspareunia negatively impacts the ability to reach orgasms and the quality of orgasms, aligning with data from both adolescents and adults and a systematic review on dyspareunia in women with endometriosis (Shi et al., 2022 ; Shum et al., 2018 ). In congruence with findings in adult women, FYA suffering from dyspareunia in our study also reported reduced sexual satisfaction(Pazmany et al., 2013 ). Our study provides a provides data from a large, representative sample of FYA and is to our knowledge the only one including such a large specter of relevant risk factors. However, several limitations need to be highlighted. The study design does not allow to infer causation. Longitudinal studies are needed to better understand the causative factors of dyspareunia, as sexual pain may be both a cause and a consequence of poor psychosocial, physical, and sexual health, complicating the determination of causal pathways. The response rate of 15.1% might have resulted in bias, as eventually only particularly motivated FYA responded and motivation for participation might have been influenced by disease symptoms. Exclusion of FYAs who have not had sexual intercourse before might add a selection bias regarding those who have avoided it due to primary dyspareunia, probably because they experienced pain already during masturbation or menstrual hygiene. However, as our prevalence rates were either lower than or comparable to those found in two other study groups, we do not think that the response rate had a relevant impact on our findings, especially as responses come from a representative sample. Another limitation is the lack of information on superficial, deep, or mixed dyspareunia, as different etiologies are associated with each subtype(Alimi et al., 2018a ; Gross & Brubaker, 2022 ; Hill & Taylor, 2021 ). The classification of dyspareunia was based on a question about pain during vaginal penetration, rather than a clinical diagnosis, and the severity of pain was not assessed. While this limits the ability to categorize dyspareunia fully, our findings still highlight key factors associated with its occurrence and underscore its importance among FYA. Social desirability bias may have influenced self-reported sexual behavior, and thus, the association between sexual behavior and dyspareunia should be interpreted with caution. Even with anonymous responding, a variety of self-reported sexual behaviors (e.g., use of condoms, number of sexual partners) correlates significantly with social desirability and may lead to under- or over-reporting(King, 2022 ). Future research should therefore incorporate measures of social desirability when addressing sensitive topics. Additionally, recall bias may affect reports of early sexual experiences, though the use of the Life History Calendar (LHC) method likely reduced this bias. The high prevalence of dyspareunia in FYA, its negative impact on sexual function and the associated reduction in sexual satisfaction makes it a clinically highly relevant problem. Potential key risk factors as poor quality of first sexual intercourse, unwanted sexual encounters, history of STDs, lower mental health scores, non-Swiss parental origin and eventually also sexual experience represent valuable targets not only to identify adolescents at risk but also to address directly. As sexual experiences during adolescence prepare sexual health throughout adulthood dyspareunia occurs in more than a third of FYA it should be systematically evaluated and addressed as a standard component of medical support in FYA. Abbreviations FYA Female young adults STD Sexually transmitted disease LHC Life history calendar FSFI-6 Female Sexual Function Index-6 FSD Female Sexual Dysfunction MHI-5 Mental health inventory NATSAL National Surveys of Sexual Attitudes and Lifestyles Declarations Ethics approval and consent to participate All data were entered with an anonymous code into an access database specifically developed for the study. The study protocol was submitted to the Ethics commission of the canton of Vaud; Cantonal Commission on Ethics in Human Research (Commission cantonale d'éthique de la recherche sur l'être humain; CER-VD), and the need for ethics approval was waived and granted exemption, as it is deemed unnecessary according to national Swiss regulations. It was realized in accordance with the Declaration of Helsinki. Informed consent was given by all participants by answering the first question of the survey. Consent for publication Not applicable Funding This research was supported by a grant from the Swiss National Science Foundation (Grant Nb162538). Availability of data and material Data is available from the corresponding author upon request. Conflict of interest All authors declare that they have no conflicts of interest. Acknowledgements We sincerely thank all the participants who took the time to complete the questionnaire and contribute to this study. Your participation was invaluable in advancing our research. We also appreciate the support and guidance of our colleagues and any institutions that facilitated this work. Author contributions statement BL contributed to the conceptualization and the design of the study. SE planned and performed the statistical analysis. SE, MR and BL drafted a first version of the manuscript. All authors SE, AN, BL and MR critically revised drafts of the manuscript, and read and approved of the final version. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6306648","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":460087654,"identity":"8b6bc32f-2bab-4b62-877a-d98f6635b0ea","order_by":0,"name":"Samia El-Hadad","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYJCCA0AswyDBAERsNmARZmK08EC1pBGnhQFJy2HCWuTbTyce+MFgw8Mg3fzwxo+y84nz+w8wfi7Ao8XgTO6Ggz0MaTwMMseMLXvO3U7ccOAAs/QMfFoYcjcc4GE4zGN/I8FMgrcNqIWxgY2ZB5/D+t9uOPiH4T/QL+nfJP+2nUuc38yAXwvDjdwNh3kYgBZJ5JhJ87YdSGw4RkCLwY23Gw7LGCSDtBRby5xLNt5whrFZGr/Dcjd/fFNhJwd02Mabb8rsZOf3Hz74Ga/DIHah8BgbCGoYBaNgFIyCUYAfAAC2REnj0JOpGAAAAABJRU5ErkJggg==","orcid":"","institution":"University Hospital Zurich","correspondingAuthor":true,"prefix":"","firstName":"Samia","middleName":"","lastName":"El-Hadad","suffix":""},{"id":460087655,"identity":"92a73f80-5ea1-4c04-a367-45c128547ff9","order_by":1,"name":"Moira Rudolphi Bsc","email":"","orcid":"","institution":"University Hospital Zurich","correspondingAuthor":false,"prefix":"","firstName":"Moira","middleName":"Rudolphi","lastName":"Bsc","suffix":""},{"id":460087657,"identity":"943381e6-0548-400a-ad99-0aeff4751f46","order_by":2,"name":"Angela Niggli","email":"","orcid":"","institution":"University Hospital Zurich","correspondingAuthor":false,"prefix":"","firstName":"Angela","middleName":"","lastName":"Niggli","suffix":""},{"id":460087658,"identity":"0b5d1b56-4a27-4a52-9c7f-2d1eea6fdd20","order_by":3,"name":"Brigitte Leeners","email":"","orcid":"","institution":"University Hospital Zurich","correspondingAuthor":false,"prefix":"","firstName":"Brigitte","middleName":"","lastName":"Leeners","suffix":""}],"badges":[],"createdAt":"2025-03-25 20:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6306648/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6306648/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83343537,"identity":"9de72281-1988-4891-a8f5-98502b36ba80","added_by":"auto","created_at":"2025-05-23 11:25:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1806264,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6306648/v1/3cc95912-b10f-4476-8a71-ab7318d9895a.pdf"},{"id":83342830,"identity":"9e9bdac4-d0e9-4273-99a6-13ecb16468e4","added_by":"auto","created_at":"2025-05-23 11:09:23","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":21875,"visible":true,"origin":"","legend":"","description":"","filename":"QuestionnaireBMCenglishversion.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6306648/v1/e3db356e873ddb164e32bb7d.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Dyspareunia and its consequences among female young adults in Switzerland – a cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith a global prevalence of 8% − 22% in adult women and an estimated life-time risk of 30%, dyspareunia, i.e. recurrent pain induced by vaginal sexual intercourse, is a burdensome and clinically highly relevant condition(Sorensen et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The consequences of chronic dyspareunia extend beyond physical discomfort and sexual health, where dyspareunia may induce a variety of secondary sexual disorders such as arousal disorders, loss of sexual desire and orgasmic dysfunction(Hämmerli et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Marques Cerentini et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2023a\u003c/span\u003e; Sorensen et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Women affected by dyspareunia face a diminished overall quality of life, reduced mental health including feelings of isolation, reduced self-esteem, negative body image perceptions, an elevated risk of relationship difficulties(De Graaff et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Hill \u0026amp; Taylor, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Schneider et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Although quality of sex life in the context of dyspareunia has been intensively investigated in adult women(Mohammadzadeh et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), women in early adulthood have so far received only little attention.\u003c/p\u003e \u003cp\u003eThe etiology of dyspareunia, is very divers, not yet fully understood and frequently remains unexplained(Hill \u0026amp; Taylor, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Gynecological factors contributing to dyspareunia encompass vulva diseases(Edwards, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), pelvic trauma associated with childbirth(McDonald et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), endometriosis(Schneider et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Yong et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), consequences of gynecological surgery(Streicher, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) or pelvic radiation(Streicher, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), pelvic inflammatory disease(Oshinowo et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), uterine myoma(Ferrero et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2006\u003c/span\u003e), retroversion of the uterus(Fauconnier et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2006\u003c/span\u003e), pelvic varices(Neĭmark et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2007\u003c/span\u003e), lichen sclerosus and other vulva diseases(Gross \u0026amp; Brubaker, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Pope et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) for example as a consequence of contraception or menopause(Hill \u0026amp; Taylor, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Additionally, recurrent vaginal or vulvar infections may be involved(Hill \u0026amp; Taylor, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Non-gynecological causes of dyspareunia include fibromyalgia, painful bladder syndrome, inflammatory bowel disease, and musculoskeletal pain(Gross \u0026amp; Brubaker, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Pope et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Furthermore, multiple psychological aspects such as relational factors, anxiety, depression, and pain catastrophizing, and of course sexual behavior may contribute to painful sexual intercourse(Leeners et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015a\u003c/span\u003e; Meana \u0026amp; Binik, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe very few available studies support an even higher prevalence of dyspareunia in young women than in elder women that has been reported to range from 20–60%(Edwards, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Landry \u0026amp; Bergeron, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2009a\u003c/span\u003e). This is quite astonishing as many of the known etiological factors are more frequent in adult women, however, available data stem from selected subgroups so that we lack representative data. Despite its considerable prevalence and the significant impact known from adult women, causes and consequences of dyspareunia in young adult women are currently underinvestigated. As sexuality is usually consolidating in this age group and first experiences strongly influence longtime sexual health and satisfaction(Long \u0026amp; Damle, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), it is particularly important to close the current knowledge gap and improve basic conditions for better counselling. Today women are hesitant to consult a health professional, health professionals do not actively address dyspareunia and there is no standard approach for diagnosis and treatment so that many women remain undiagnosed and untreated(Maurice \u0026amp; Bowman, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). The situation is likely to be even worse in young females, where sexuality is still developing and open communication with health professionals, friends, family, or a partner is often experienced as challenging and uncomfortable but would be highly beneficial for a healthy development of sexuality. In addition to improved counselling, early identification of dyspareunia in adolescents might help to counteract chronification as pain processing may be modified through severe pain experiences and no longer be reversible thereafter(Landry \u0026amp; Bergeron, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2009b\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAims\u003c/p\u003e \u003cp\u003eTherefore, this study aims (i) to assess the prevalence of dyspareunia among a representative group of female young adults (FYA) and (ii) to identify differences in the biomedical, behavioral, and psychosocial profile of sexually active FYA affected by dyspareunia compared to sexually active pain-free FYA. Furthermore, it is our goal to (iii) evaluate potential effects of early dyspareunia on later sexual function and satisfaction.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eStudy design: The Swiss national survey on youth sexual behaviors was conducted as a representative, cross-sectional study of young adults with a mean age of 26 years in 2017. The initial representative sample (gender; language: French, Italian or German; canton of residence) of the 24–28 years old population living in Switzerland was provided by the Swiss Federal Office of Statistics. Study participants were invited with a postal information letter together with a unique login code to participate in an online self-administrated questionnaire. The questionnaire was developed specifically for this study and available in German, French and Italian. The electronic version of the questionnaire allowed to capture how much time the respondents spent on answering the questionnaire and whether they completed it continuously or provided their answers in several sessions with pauses in-between. For each section of the questionnaire differentiated analysis of the number of questions answered were realized. Only respondents who had answered at least 80% of the relevant questions were considered in our present analysis. The questionnaire used internationally validated previously used questionnaires wherever possible, so that we refrained from further tests to reevaluate reliability and validity.\u003c/p\u003e\u003cp\u003eThe design of the present study was based on a previous survey conducted in 1996 (Ottesen et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2002\u003c/span\u003e)\u003csup\u003e,\u003c/sup\u003e(Leeners et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). A complete and detailed version of the study design, as well as a French and English version of the questionnaire as an EXCEL file are available in the Supplementary materials. The survey collected sociodemographic, sexual health and behavior data using a life history calendar (LHC) approach. The LHC is a data collection approach that facilitates recall of past events by using the individual’s own past experiences as cues for remembering(Martyn et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Morselli et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The manuscript was drafted following STROBE criteria(von Elm et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn- and exclusion criteria: For the present evaluation young women without gender dysphoria describing themselves as heterosexually oriented were evaluated. For sexual orientation, we used a multidimensional approach including sexual orientation identity, sexual attraction, and sex of sexual partner(s)(Von Rosen et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Waltermaurer et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Furthermore, we excluded participants who had never had sexual intercourse as dyspareunia can per definition only be diagnosed in the context of intercourse.\u003c/p\u003e\u003cp\u003eThe categorization between young women experiencing dyspareunia and those with pain-free sexual intercourse was made based on the question: “Are you regularly experiencing pain during vaginal penetration?” with the option to answer “Yes” or “No”. We assessed occurrence of dyspareunia as experienced by the study participant and investigated the degree of sexual satisfaction by using the Female Sexual Function Index-6 (FSFI-6), a 6-item, brief, and self-administered instrument derived from the original 19-item FSFI that measures female sexual function. It comprises the six domains desire, arousal, lubrication, orgasm, satisfaction, and pain. Desire and satisfaction items are rated on a 5-point Likert scale, ranging from 1 to 5, and the other items are rated on a 6-point Likert scale, ranging from 0 to 5. Total scores may vary between 2 and 30, with lower scores indicating worse sexual functioning. We calculated individual domain scores and an overall score (sum of domain scores) of the FSFI (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Women who scored \u0026lt; 19 were classified as having Female Sexual Dysfunction (FSD)(Isidori et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSociodemographic and personal characteristics included age, origin of parents, place of residence (urban, rural) and attained education level. We included parental origin as a variable because cultural attitudes and sexuality seem to be strongly linked(Bober \u0026amp; Chevalier, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Espinosa-Hernández et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo assess general health and health-conscious behavior we collected information on mental health and on the presence of chronic disease. We evaluated the association between dyspareunia and general as well as mental health status. Depression and anxiety were assessed with the mental health inventory (MHI-5) using 5 items referring to the last 4 weeks (Berwick et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e1991\u003c/span\u003e): \u003cem\u003e“How much of the time during the past 4 weeks have you… (1) been a very nervous person? (2) felt so down in the dumps that nothing could cheer you up? (3) felt calm and peaceful? (4) felt downhearted and blue? (5) been a happy person?”\u003c/em\u003e The mental health score ranges from 0 to 100 with higher values representing better health. As recommended by previous authors, we used a cut-off of ≤ 52 to differentiate between reduced and normal mental health(Bayley et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Cameron et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAge at menarche and a history of sexually transmitted diseases (STDs) served to evaluate gynecological health status. We investigated type of present relationship, own age at the first steady partnership and sexual risk behavior. Frequently or sometimes having sex after consummation of drugs or alcohol, without contraception as well as an age below 14 years at the time of the 1st sexual intercourse and having more than 10 lifetime sex partners were classified as sexual risk behavior. To assess experiences at 1st sexual intercourse we used modified questions from the National Surveys of Sexual Attitudes and Lifestyles (NATSAL), the largest survey of sexual behavior in the world(K. R. Mitchell et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). We assessed experiences of undesired, but voluntary sexual experiences by asking: “In the course of your life, have any of your sexual contacts or relationships been unwanted?” and “Have you ever accepted sex you didn't really want to have?”. The question: “Have you ever been sexually assaulted or abused? (Sexual assault or abuse is when someone forces you)” was used to assess the history of sexual abuse.\u003c/p\u003e\u003cp\u003e Ethics: All data were entered with an anonymous code into an access database specifically developed for the study. The study protocol was submitted to the Ethics commission of the canton of Vaud (CER-VD) and granted exemption, as it did not need to be evaluated according to Swiss law. It was realized in accordance with the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003eStatistics: We performed bivariate analysis to compare the characteristics of young women presenting with and without dyspareunia. Chi-Square (Χ²) test was used to assess this difference with respect to categorical variables and Mann-Whitey-U-test was applied to evaluate the equality of the group means over continuous variables. A p-value of less than 0.05 was considered statistically significant. We presented descriptive statistics to summarize results. Subsequently, we conducted multivariate logistic regression analysis to evaluate factors associated with the occurrence of dyspareunia and calculated p-values, adjusted p-values, as well as adjusted odds ratios (OR). Statistical analysis was performed using the R-Software, Version 4.1.2.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe final sample included 2789 female participants (response rate 15.1%). After excluding participants who reported gender dysphoria, identified as homosexually oriented, and/or had not engaged in vaginal intercourse yet, 2718 FYA were available for statistical analysis. A total of 2059 participants reported whether they suffer from dyspareunia or not, while the remaining 659 participants answered: \u0026ldquo;I don\u0026rsquo;t want to answer\u0026rdquo; or \u0026ldquo;I don\u0026rsquo;t know\u0026rdquo; and were excluded from the analysis. Altogether, of the 2789 FYA who provided an answer 723 (35.1%) reported experiencing dyspareunia.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e displays sociodemographic data for FYA with and without dyspareunia. Both parents being non-Swiss-born was positively associated with the occurrence of dyspareunia while educational status and residential area showed no association with dyspareunia.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics among FYA with dyspareunia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFYA with dyspareunia\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;723\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFYA without dyspareunia\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1372\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (mean \u0026plusmn; SD in years)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.35 \u0026plusmn; 0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.30 \u0026plusmn; 0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParents born in CH (N/%)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth Swiss-born\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e459 (63.49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e989 (72.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne Swiss-born\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113 (15.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e205 (14.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth non-Swiss-born\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e151 (20.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e178 (12.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest education level (N/%)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.537\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMandatory school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (0.97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (0.73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVocational training, apprenticeship\u003c/p\u003e \u003cp\u003eProfessional maturity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e185 (25.59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e388 (28.28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh School Diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78 (10.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146 (10.64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e430 (59.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e784 (57.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence area, urban vs rural (N/%)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.769\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e1\u003c/sup\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e319 (44.12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e616 (44.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e2\u003c/sup\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e404 (55.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e756 (55.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eSD: Standard deviation; CH: Switzerland; N: Numbers\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMetric variables are marked with * and were evaluated using the Mann-Whitney-U-test\u003c/p\u003e \u003cp\u003eCategorical variables are marked with ** and were evaluated using the chi-square-test\u003c/p\u003e \u003cp\u003ep-values are presented as adjusted p-values; significant p-values are marked in bold\u003c/p\u003e \u003cp\u003e \u003csup\u003e1\u003c/sup\u003e Urban: city, suburb of a city (more than 10,000 inhabitants), \u003csup\u003e2\u003c/sup\u003e Rural: mountains, countryside, village (less than 10,000 inhabitants)\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents general and sexual health information. FYA with dyspareunia had a lower mental health score (65.70, SD\u0026thinsp;=\u0026thinsp;14.40 vs. 70.62, SD 13.62, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among FYA with dyspareunia the number of those suffering from a chronic disease was slightly higher compared to those participants having no dyspareunia (17.70% vs 14.65%, p\u0026thinsp;=\u0026thinsp;0.036). In addition, FYA with dyspareunia were more likely to report a previous diagnosis of an STD (33.75% vs. 30.54%, p\u0026thinsp;=\u0026thinsp;0.037).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral and genital health data among FYA with Dyspareunia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFYA with dyspareunia\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;723\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFYA without dyspareunia\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1372\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMental health sum score (mean \u0026plusmn; SD)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65.70 \u0026plusmn; 14.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.62 \u0026plusmn; 13.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChronic disease (N/%)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128 (17.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e201 (14.65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.036\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMenarche (mean \u0026plusmn; SD in years)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.60 \u0026plusmn; 2.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.58 \u0026plusmn; 2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.910\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSTDs diagnosed ever (N/%) **\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e244 (33.75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e419 (30.54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.037\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eSD: Standard deviation; N: Numbers\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMetric variables are marked with * and were evaluated using the Mann-Whitney-U-test\u003c/p\u003e \u003cp\u003eCategorical variables are marked with ** and were evaluated using the chi-square-test\u003c/p\u003e \u003cp\u003ep-values are presented as adjusted p-values; significant p-values are marked in bold\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarizes information on the history of partnerships and sexuality. FYA with a higher age at their first steady partnership, first sexual intercourse, and a lower number of overall lifetime sex partners were more likely to report dyspareunia. However, although associations between those variables and dyspareunia were statistically significant on a bivariate level, numbers were very similar, and consequently clinical relevance needs to be interpreted with caution.\u003c/p\u003e \u003cp\u003eAge and type of relationship during the first sexual intercourse, feelings of regret about it, and sexual risk behaviors such as intercourse without contraception or while intoxicated/drugged showed no correlation with dyspareunia. FYA with dyspareunia experienced their first sexual intercourse as less pleasant (20.61% vs. 30.32%, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and remembered it more frequently as disagreeable or very unpleasant (34.02% vs. 24.13%, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Negative sexual experiences, such as accepting sex without really wanting it, were significantly associated with dyspareunia, while the prevalence of sexual assault did not differ between the groups. Communicating with parents about sexuality was less common among FYA with dyspareunia (25.86% vs. 33.09%; p-value\u0026thinsp;=\u0026thinsp;0.020).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHistory of partnership, sexuality and sexual behavior among FYA with dyspareunia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFYA with Dyspareunia\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;723\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFYA without dyspareunia\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1372\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge at 1st steady partnership\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mean \u0026plusmn; SD)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.50 \u0026plusmn; 2.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.15 \u0026plusmn; 2.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber lifetime sex partners (N/%)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139 (19.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e229 (16.69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e181 (25.03%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e291 (21.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e190 (26.28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e352 (25.66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (10.65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e178 (12.97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e136 (18.81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e322 (23.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge 1st sexual intercourse (mean \u0026plusmn; SD)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.63 \u0026plusmn; 2.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.22 \u0026plusmn; 2.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1st sexual intercourse within a stable relationship? (N/%)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e535 (74.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1033 (75.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.610\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReflections on 1st sexual intercourse with vaginal penetration (N/%)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.634\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI shouldn't have done it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (9.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127 (9.26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI should have waited longer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78 (10.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e144 (10.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI should not have waited so long\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (2.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (2.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIt was the right time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e491(67.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e961 (70.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerception of 1st sexual intercourse (N/%)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery nice/ Pleasant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e149 (20.61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e416 (30.32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeither pleasant nor unpleasant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e302 (41.77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e570 (41.55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagreeable/ Very unpleasant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e246 (34.02%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e331 (24.13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMain person to discuss sexuality (N/%)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother/Father\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e187 (25.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e454 (33.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131 (18.12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e204 (14.87%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFriends/ other family members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e290 (40.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e534 (38.92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (2.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (1.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (5.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (5.32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver engaging in sex not really wanted (N/%)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e271 (37.48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e641 (46.72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, one time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184 (25.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e309 (22.52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, multiple times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e264 (36.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e418 (30.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver having been sexually assaulted or abused (N/%)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98 (13.55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e199 (14.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSexual intercourse while intoxicated or high on drugs (N/%)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.570\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (2.35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (2.62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes/Rarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e319 (44.12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e618 (49.42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e387 (53.53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e718 (52.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSexual intercourse without contra-ception (N/%)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.777\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (6.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (5.03%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes/Rarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e357 (49.38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e713 (51.97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e322 (44.54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e590 (43.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSD: Standard deviation; N:Numbers\u003c/p\u003e \u003cp\u003eMetric variables are marked with * and were evaluated using the Mann-Whitney-U-test\u003c/p\u003e \u003cp\u003eCategorical variables are marked with ** and were evaluated using the chi-square-test\u003c/p\u003e \u003cp\u003ep-values are presented as adjusted p-values; significant p-values are marked in bold\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents FSFI-scores among participants. FYA dyspareunia reported lower scores in all six domains and lower total FSFI-6 sum scores compared to FYA without dyspareunia. A total of 124 (17.15%) of FYA with dyspareunia reached FSFI-6 sum scores\u0026thinsp;\u0026lt;\u0026thinsp;19, indicating sexual dysfunction, compared to 48 (3.5%) in the group without dyspareunia.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSexual satisfaction and FSFI-6-item score among FYA with and without dyspareunia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScore-range\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFYA with dyspareunia\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;723\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFYA without dyspareunia\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1372\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDesire (mean \u0026plusmn; SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1\u0026ndash;5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.3 \u0026plusmn; 0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.60 \u0026plusmn; 0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eArousal (mean \u0026plusmn; SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0\u0026ndash;5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.73 \u0026plusmn; 0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.05 \u0026plusmn; 0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLubrification (mean \u0026plusmn; SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0\u0026ndash;5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.93 \u0026plusmn; 1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.56 \u0026plusmn; 0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOrgasm (mean \u0026plusmn; SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0\u0026ndash;5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.60 \u0026plusmn; 1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.86 \u0026plusmn; 1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSatisfaction (mean \u0026plusmn; SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0\u0026ndash;5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.05 \u0026plusmn; 1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.38 \u0026plusmn; 0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePain (mean \u0026plusmn; SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0\u0026ndash;5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.41 \u0026plusmn; 0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.00 \u0026plusmn; 0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal FSFI-6-item Score\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mean \u0026plusmn; SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.04 \u0026plusmn; 4.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.46 \u0026plusmn; 3.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFSFI-6 sum score\u0026thinsp;\u0026lt;\u0026thinsp;19\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e \u003cb\u003e(N/%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124 (17.15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 (3.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e1\u003c/sup\u003e A score\u0026thinsp;\u0026lt;\u0026thinsp;19 represents sexual dysfunction\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAll subscores, as well as the total FSFI-scores were evaluated using the Mann-Whitney-U-test\u003c/p\u003e \u003cp\u003ep-values are presented as adjusted p-values; significant p-values are marked in bold\u003c/p\u003e \u003cp\u003eAfter conducting multivariate regression analysis (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), both parents being non-Swiss remained a statistically significant predictor for dyspareunia (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001; OR 1.64 to suffer from dyspareunia if both parents are non-Swiss compared to Swiss parents). A higher mental health score correlated negatively with the occurrence of dyspareunia, e.g. a drop of 5 points in the average mental health score of FYA showed an increased likelihood of suffering from dyspareunia (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001; OR 1.98 for FYA with average mental health scores of 65.70 \u0026plusmn; 14.4 compared to those with 70.62 \u0026plusmn; 13.62). A diagnosis of STDs, a negative experience at the first sexual intercourse, and accepting unwanted sex also remained significant correlates of dyspareunia. Increasing numbers of lifetime partners significantly correlated with a decreased likelihood for FYA to experience dyspareunia (2\u0026ndash;3 lifetime partners p-value\u0026thinsp;=\u0026thinsp;0.28, OR 1.65; 4\u0026ndash;7 lifetime partners p-value\u0026thinsp;=\u0026thinsp;0.02, OR 1.65; 8\u0026ndash;10 lifetime partners p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001, OR 2.38; \u0026gt; 10 lifetime partners p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001, OR 2.44). Communicating about sexuality with their parents in comparison to friends showed a decreased risk for suffering from dyspareunia (p-value\u0026thinsp;=\u0026thinsp;0.04, OR 0.76).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate logistic regression evaluating the association between different socio-epidemiologi-cal, as well as general, and sexual health factors and the occurrence of dyspareunia in FYA\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEstimate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwiss parents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth non-Swiss-born\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne Swiss-born\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.19\u0026ndash;0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth Swiss-born\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.13\u0026ndash;0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChronic disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, non-limiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.542 -0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, limiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.19\u0026ndash;1.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObligatory school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApprenticeship/Baccalaureate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-2.58\u0026ndash;0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity of Applied Sciences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-2.69\u0026ndash;0.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-2.79\u0026ndash;0.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence area\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e1\u003c/sup\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e2\u003c/sup\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.17\u0026ndash;0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge at menarche\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.03\u0026ndash;0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMental health score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.03 - -0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSTDs diagnosed ever\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.47\u0026ndash;0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge at first steady partnership\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.07\u0026ndash;0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of lifetime sex partners\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.16\u0026ndash;0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.07\u0026ndash;0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.34\u0026ndash;1.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.37\u0026ndash;1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge at first sexual intercourse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.08\u0026ndash;0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of relationship at first sexual intercourse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccasional/flirt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.51\u0026ndash;0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegretting first sexual intercourse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot right moment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight moment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.58\u0026ndash;0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.65\u0026ndash;0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQuality first sexual Intercourse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood/very good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.66 - -0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBad/very bad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-1.06 - -0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunication about sexuality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.54\u0026ndash;0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFriends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.53 - -0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.72\u0026ndash;0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.66\u0026ndash;0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex without wanting it\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.44\u0026ndash;0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.58 - -0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSexual abuse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.07\u0026ndash;0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex without contraception\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes/rarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.25\u0026ndash;0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.05\u0026ndash;1.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex while on alcohol/drugs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes/rarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.73\u0026ndash;0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.81\u0026ndash;0.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eOR: Odds ratio; SE: Standard error; 95% CI: 95% Confidence interval\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eAs reference category for performing multivariate logistic regression analysis, we used the group with dyspareunia\u003c/h2\u003e \u003cp\u003eSignificant p-values are marked in bold\u003c/p\u003e \u003cp\u003e \u003csup\u003e1\u003c/sup\u003e Urban: city, suburb of a city (more than 10,000 inhabitants), \u003csup\u003e2\u003c/sup\u003e Rural: mountains, countryside, village (less than 10,000 inhabitants)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this large national sample, more than one in four FYA reported dyspareunia. The condition was particularly prevalent among FYA with poor first sexual experiences, a history of unwanted sexual encounters, a history of STDs, fewer lifetime sexual partners, lower mental health scores, and non-Swiss parentage. As expected, FYA with dyspareunia also exhibited higher rates of sexual dysfunction and reduced sexual satisfaction.\u003c/p\u003e \u003cp\u003eOur study found a 35.1% prevalence of dyspareunia in FYA, which is far higher than the 8\u0026ndash;21% reported in adults(Alimi et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018a\u003c/span\u003e; Sorensen et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). This aligns with other studies highlighting a particularly high risk in younger women(Fergus et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; K. Mitchell et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). In sexually active girls with an average age of 19 years painful intercourse has been reported by one out of three girls(Berglund et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) and out of 300 13\u0026ndash;21-year-old young women recruited in a youth center in Sweden even 49% reported dyspareunia(Elmerstig et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). These higher rates in comparison to our study may have to be attributed to the lower age of the participants which may be related to a higher percentage of participants engaging in intercourse not only or not at all motivated by desire. Recruitment of different study groups and differences in the definition of dyspareunia further hamper comparison of results. However, all studies confirm high rates of painful intercourse among FYA, which need to be addressed to improve actual sexual satisfaction and reduce the risk for an unfavorable development of future sexual health.\u003c/p\u003e \u003cp\u003eFYA who had their first steady partnership and sexual intercourse at an older age were more likely to report dyspareunia, consistent with other studies(Donders et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Despite statistically significant differences, absolute numbers were very similar, so that these results should be interpreted with caution. Expectations and tension surrounding first sexual intercourse may vary based on prior discussions, and age-related fibrosis of the posterior hymen might increase dyspareunia risk(Donders et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Women who experience pain from genital contact may avoid sexual activities, potentially explaining why those with dyspareunia initiated sexual relations later and had fewer lifetime partners(Meana \u0026amp; Binik, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; K. Mitchell et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). However, distinguishing between causes and symptoms remains challenging.\u003c/p\u003e \u003cp\u003eOur findings indicate that the quality of the first sexual intercourse significantly correlates with the occurrence of dyspareunia. Multivariate logistic regression showed that a negative first sexual experience is associated with a higher risk of suffering from dyspareunia (OR 1.25). While most studies support the formative impact of early sexual experiences on young women(Cacciatore et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Van De Bongardt et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), some contradict this(Elmerstig et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). The link between sexual experiences and dyspareunia is further reinforced by its higher prevalence among participants who engaged in sexual encounters voluntarily but without genuine desire. Reported reasons included lack of self-confidence, inexperience, aiming to maintain a relationship, love, substance influence, fear of saying no, or own ambiguous behavior.\u003c/p\u003e \u003cp\u003eWhereas some studies found a correlation between sexual abuse experiences and dyspareunia (Leclerc et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Tetik \u0026amp; Yal\u0026ccedil;ınkaya Alkar, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), other findings including our own results did not confirm a direct association(Santerre-Baillargeon et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). We found a significant correlation between dyspareunia and undesired, yet voluntary, sex, with no direct link to sexual abuse. This supports the mixed findings in previous research. Relationship dynamics, such as partner familiarity and intercourse frequency, likely play a role and should be explored further, including the influence of attachment anxiety.\u003c/p\u003e \u003cp\u003eAlthough we did not find a significant link between dyspareunia and sexual abuse, poor mental health\u0026mdash;often a result of abuse\u0026mdash;is associated with an increased risk of dyspareunia. In agreement with other studies we found a 20% higher frequency of reduced mental health in FYA with dyspareunia(Basson \u0026amp; Weijmar Schultz, 2007; Wylie et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). In adult women, most studies show higher depression scores in women with dyspareunia(Jackowich et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Leeners et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2015b\u003c/span\u003e). Mental health disorders can both cause and result from dyspareunia, so addressing one may improve the other(Davis et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Early treatment of dyspareunia could enhance both sexual and mental health, and FYA with depression and anxiety may benefit from targeted sexual counseling.\u003c/p\u003e \u003cp\u003eFYA with dyspareunia were more likely to report previous STDs, which is in line with the known role of genital and vaginal infections\u0026mdash;especially when recurrent or inadequately treated\u0026mdash;as causes of dyspareunia(Alimi et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018b\u003c/span\u003e; Edgardh \u0026amp; Abdelnoor, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). Central sensitization is one of the suspected underlying mechanisms(Sadownik, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Increased STD exposure may indicate sexual encounters not driven by self-confident desire, augmenting the risk of tension-related dyspareunia. Additionally, some FYA may endure painful sex to protect their self-image(Elmerstig et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Psychological and sexual counseling is recommended to boost self-confidence and support healthy sexual relationships with a reduced risk of dyspareunia.\u003c/p\u003e \u003cp\u003eOur findings align with previous research showing a correlation between chronic (gynecological) diseases and dyspareunia(Shi et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Conditions like endometriosis are strongly associated with painful sexual activities(K. Mitchell et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). However, we lacked specific data on participants' chronic diseases, necessitating future research to explore the underlying mechanisms, such as whether differences in pain perception contribute to various chronic pain disorders or if one pain disease increases the risk for others.\u003c/p\u003e \u003cp\u003eWe also found a significant link between dyspareunia and having non-Swiss parents. Given that the effective difference in this variable is relatively small and the inherent variability of non-Swiss population, it is likely that we have captured an effect that is more attributable to culturally influenced attitudes and concepts regarding sexuality. Attitudes and societal views on intimacy and sexual satisfaction likely contribute to dyspareunia, supported by geographical and ethnic variations in prevalence(Harlow et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). These differences may indicate variations in tension-related attitudes towards sexuality, but also in discomfort interpretation and symptom reporting.\u003c/p\u003e\n\u003ch3\u003eDyspareunia and quality of sexuality\u003c/h3\u003e\n\u003cp\u003eOur study found that FSFI-6 scores were, on average, 3 points lower in FYA with dyspareunia, consistent with previous research, showing an increased risk of secondary sexual dysfunction in women with dyspareunia(De Graaff et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Sorensen et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Altogether, 17% of FYA with dyspareunia experienced secondary sexual dysfunction compared to 3.5% without dyspareunia, underscoring the importance of evaluating dyspareunia in the context of other sexual complaints. In a Brazilian student sample the prevalence of female sexual dysfunction in women with dyspareunia was 23% (Marques Cerentini et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023b\u003c/span\u003e), but a direct comparison with our findings is not possible because the study population was smaller evaluating data from 187 students. In another study, American students reported frequent pain during in 19% and occasional pain in 24% during sexual intercourse(Azim et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Dyspareunia negatively impacts the ability to reach orgasms and the quality of orgasms, aligning with data from both adolescents and adults and a systematic review on dyspareunia in women with endometriosis (Shi et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Shum et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In congruence with findings in adult women, FYA suffering from dyspareunia in our study also reported reduced sexual satisfaction(Pazmany et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study provides a provides data from a large, representative sample of FYA and is to our knowledge the only one including such a large specter of relevant risk factors.\u003c/p\u003e \u003cp\u003eHowever, several limitations need to be highlighted. The study design does not allow to infer causation. Longitudinal studies are needed to better understand the causative factors of dyspareunia, as sexual pain may be both a cause and a consequence of poor psychosocial, physical, and sexual health, complicating the determination of causal pathways.\u003c/p\u003e \u003cp\u003eThe response rate of 15.1% might have resulted in bias, as eventually only particularly motivated FYA responded and motivation for participation might have been influenced by disease symptoms. Exclusion of FYAs who have not had sexual intercourse before might add a selection bias regarding those who have avoided it due to primary dyspareunia, probably because they experienced pain already during masturbation or menstrual hygiene. However, as our prevalence rates were either lower than or comparable to those found in two other study groups, we do not think that the response rate had a relevant impact on our findings, especially as responses come from a representative sample.\u003c/p\u003e \u003cp\u003eAnother limitation is the lack of information on superficial, deep, or mixed dyspareunia, as different etiologies are associated with each subtype(Alimi et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018a\u003c/span\u003e; Gross \u0026amp; Brubaker, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Hill \u0026amp; Taylor, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The classification of dyspareunia was based on a question about pain during vaginal penetration, rather than a clinical diagnosis, and the severity of pain was not assessed. While this limits the ability to categorize dyspareunia fully, our findings still highlight key factors associated with its occurrence and underscore its importance among FYA.\u003c/p\u003e \u003cp\u003eSocial desirability bias may have influenced self-reported sexual behavior, and thus, the association between sexual behavior and dyspareunia should be interpreted with caution. Even with anonymous responding, a variety of self-reported sexual behaviors (e.g., use of condoms, number of sexual partners) correlates significantly with social desirability and may lead to under- or over-reporting(King, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Future research should therefore incorporate measures of social desirability when addressing sensitive topics. Additionally, recall bias may affect reports of early sexual experiences, though the use of the Life History Calendar (LHC) method likely reduced this bias.\u003c/p\u003e \u003cp\u003eThe high prevalence of dyspareunia in FYA, its negative impact on sexual function and the associated reduction in sexual satisfaction makes it a clinically highly relevant problem. Potential key risk factors as poor quality of first sexual intercourse, unwanted sexual encounters, history of STDs, lower mental health scores, non-Swiss parental origin and eventually also sexual experience represent valuable targets not only to identify adolescents at risk but also to address directly. As sexual experiences during adolescence prepare sexual health throughout adulthood dyspareunia occurs in more than a third of FYA it should be systematically evaluated and addressed as a standard component of medical support in FYA.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eFYA Female young adults\u003c/p\u003e \u003cp\u003eSTD Sexually transmitted disease\u003c/p\u003e \u003cp\u003eLHC Life history calendar\u003c/p\u003e \u003cp\u003eFSFI-6 Female Sexual Function Index-6\u003c/p\u003e \u003cp\u003eFSD Female Sexual Dysfunction\u003c/p\u003e \u003cp\u003eMHI-5 Mental health inventory\u003c/p\u003e \u003cp\u003eNATSAL National Surveys of Sexual Attitudes and Lifestyles\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eAll data were entered with an anonymous code into an access database specifically developed for the study. The study protocol was submitted to the Ethics commission of the canton of Vaud; Cantonal Commission on Ethics in Human Research (Commission cantonale d\u0026apos;\u0026eacute;thique de la recherche sur l\u0026apos;\u0026ecirc;tre humain; CER-VD), and the need for ethics approval was waived and granted exemption, as it is deemed unnecessary according to national Swiss regulations. It was realized in accordance with the Declaration of Helsinki. Informed consent was given by all participants by answering the first question of the survey.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis research was supported by a grant from the Swiss National Science Foundation (Grant Nb162538).\u003c/p\u003e\n\u003ch2\u003eAvailability of data and material\u003c/h2\u003e\n\u003cp\u003eData is available from the corresponding author upon request.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eConflict of interest\u003c/h2\u003e\n\u003cp\u003eAll authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eWe sincerely thank all the participants who took the time to complete the questionnaire and contribute to this study. Your participation was invaluable in advancing our research. We also appreciate the support and guidance of our colleagues and any institutions that facilitated this work.\u003c/p\u003e\n\u003ch2\u003eAuthor contributions statement\u003c/h2\u003e\n\u003cp\u003eBL contributed to the conceptualization and the design of the study. SE planned and performed the statistical analysis. SE, MR and BL drafted a first version of the manuscript. All authors SE, AN, BL and MR critically revised drafts of the manuscript, and read and approved of the final version.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlimi Y, Iwanaga J, Oskouian RJ, Loukas M, Tubbs RS. The clinical anatomy of dyspareunia: A review. 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Sex Med. 2017;5(3):e184\u0026ndash;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.esxm.2017.07.001\u003c/span\u003e\u003cspan address=\"10.1016/j.esxm.2017.07.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"dyspareunia, pelvic pain, female sexual dysfunction, young adult","lastPublishedDoi":"10.21203/rs.3.rs-6306648/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6306648/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground/Objective(s)/Introduction: Dyspareunia is known to be highly prevalent, but knowledge about prevalences, consequences and etiology among young female adults (FYA) remains. This study aims to examine prevalences and key factors associated with dyspareunia in sexually active FYAs.\u003c/p\u003e \u003cp\u003ePatients/Materials and Methods: We systemically evaluated data from a large representative sample of FYAs in Switzerland who participated in an online self-administrated questionnaire. Participants reported on behavioral, psychosocial factors as well as on sexual history and a structured comparison between FYAs with and without dyspareunia was performed. To assess sexual functioning, we used the Female Sexual Function Index-6.\u003c/p\u003e \u003cp\u003eResults: We evaluated 2718 questionnaires, of which 2059 provided an answer on having dyspareunia or not. We found a prevalence of 35.1% for dyspareunia among FYAs. Cases who reported a lower number of lifetime sexual partners, who perceived the quality of their first sexual intercourse as poor, who accepted unwanted sexual encounters and/ or had a history of STDs suffered significantly more often from dyspareunia. After conducting multivariate regression analysis, both parents being non-Swiss and poor mental health remained statistically significant predictors for dyspareunia, with an almost 20% increased risk. Having a higher number of lifetime partners was associated with a 12% reduced likelihood to experience dyspareunia (p-value\u0026thinsp;=\u0026thinsp;0.005; OR 0.88). Sexual dysfunction was found to be significantly more frequent in FYAs with dyspareunia (p-value\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eConclusions: Dyspareunia is highly prevalent among FYAs leading to significantly reduced sexual functioning. Further longitudinal research is essential to gain a deeper understanding of the causative influence of the various identified risk factors.\u003c/p\u003e","manuscriptTitle":"Dyspareunia and its consequences among female young adults in Switzerland – a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-23 11:09:18","doi":"10.21203/rs.3.rs-6306648/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-06-14T21:20:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"324146847829669337219442474109073362269","date":"2025-06-05T12:22:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"274293949576553924896160521305855947485","date":"2025-05-31T17:47:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-21T15:03:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-13T10:55:24+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-21T06:32:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-20T09:45:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-04-20T09:44:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fd6d7758-96d5-4b35-9648-6fbe067af8e7","owner":[],"postedDate":"May 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-23T11:09:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-23 11:09:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6306648","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6306648","identity":"rs-6306648","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}