Sexual Knowledge, Attitudes and Behaviours among Undergraduate Students in China—Implications for Sex Education

Background: Despite rapid modernization and improving gender equity in China in recent decades, traditional values prevail in many areas of life, including sexual behavior. This study aimed to explore gender differences in sexual knowledge, sexual attitudes and sexual behaviors, as well as preferences for sex education among undergraduates in China. Methods: A cross-sectional study surveyed 5965 undergraduates (62.8% females), aged 15 to 24 years from nine universities in Zhejiang, Henan and Yunnan provinces, from September to November 2019. Results: Of the total sample, 158 (2.6%) self-identified as homosexual, 287 (4.8%) as bisexual and 324 (5.4%) stated they were unclear about their sexual identity. The mean sexual knowledge score out of 12 was 6.16 ± 2.54 points. Ever having sexual intercourse was reported by 18.7% (27.0% males, and 13.9% females). Students from urban backgrounds, and those with homosexual and bisexual orientation were more likely to have had sexual intercourse. Most students (72.5%) reported that they would prefer to receive sex education from on-line sources. Conclusions: Female students are significantly more conservative in sexual attitudes and sexual behaviors. Low levels of sexual knowledge contribute to risk behaviors among Chinese adolescents. China needs to develop and widely disseminate on-line sex education, with practical, age-appropriate content.