Sexual health and sexual behaviours in Chinese women of varied sexual identities: a sequential mixed methods study.

Globally, sex research has largely centred on Western contexts and has often overlooked women's sexuality. In China, there is a dearth of literature on women's sexual health and behaviours, especially those of sexual and gender minorities. This mixed-methods study addresses this gap by investigating the sexual health, behaviours, and lived experiences of Chinese women with diverse sexual identities. A cross-sectional online survey was conducted in 2021, followed by qualitative interviews in 2022-2023. Overall, 509 women aged 18-56 years participated in the survey, including 250 cisgender heterosexual women, 186 cisgender sexual minority women, and 73 transgender women or individuals assigned female at birth who identify as nonbinary. Additionally, semi-structured interviews were conducted with 33 participants (5 cis-heterosexual women, 18 sexual minority women, 2 transgender women, and 8 nonbinary individuals). Quantitative findings indicated that cis-heterosexual women tended to confirm their sexual identities at an earlier age but initiated sexual practices later than minority participants. Regarding safer sex behaviours, consistent condom use was more prevalent among cis-heterosexual women. In contrast, sexual minority participants, reflecting the diversity of their sexual practices, more often adopted women-controlled safer sex strategies, such as cleaning before sex. Four overarching themes were developed, including (1) women's sexuality has long been invisible but is changing; (2) diverse sexual identities and complex sexual practices; (3) the bond between sex and self-worth; and (4) disparities in safer sex awareness and practice. These findings underscore the crucial role of sexual identity and cultural context in the articulation and experiences of women's sexuality and sexual health.