The results of the present study directly and indirectly indicated the rate of sexual behaviors among the medical sciences students in the 8th macro region of Iran. Based on the results of the present study, the incidence of premarital sexual behaviors was higher among the male students than their female counterparts. Studies have shown that sexual behaviors in women are affected by sexual morality and expectations, and women prefer to have sexual relationships to those they would like to get married. However, men report a higher level of sexual experiences as well as allowable sexual attitudes compared to women (18). Furthermore, remaining virgin before marriage is more important to women than men (19).
Based on the results derived from data analyzing, the major sexual behavior among both male and female students was watching pornographic movies with 23.1% in the direct method and 22.9% in the indirect method, respectively, which is in line with the studies of Vakilian et al. (20), Zahedi et al. (21) and Khalilabadi et al. (22) in Iran. Access to technology and communication media, cell phone, and internet can justify this issue (20, 23). Following pornography, masturbation with the frequency of 18.6% in the direct method and 19.5% in the indirect method was reported as the second most common premarital sexual behavior. Another study in China also reported higher rate of watching pornographic movies as compared to other sexual behaviors among students, and also in line with the present research, the second reported sexual behavior was masturbation (1). In another study by Kasemy conducted in Egypt as a Muslim country, watching pornography and masturbation were also reported as the main sexual behaviors among the youth, which is in line with the present study (24). This kind of sexual behaviors may be related to cultural issues and tabooing the relationships with the opposite sex in Islamic and even Asian countries.
In a study in the US, masturbation was stated as the most common sexual behavior among the youth, with 92% of men and 48% of women reporting this behavior respectively (25). The results of another study showed that 73.8% and 48.1% of adult American men and women respectively experienced masturbation; the prevalence of this behavior and its frequency increased in these individuals in higher ages (26). Another study in US mentioned to high frequency of non-vaginal methods especially before marriage in those who preferred to keep their virginity but be sexually active, thus, the rate of vaginal sexual behaviors has decreased, while the methods such as masturbation as well as oral and anal sex have increased (25). In the present study, sexual behaviors such as vaginal intercourse and homosexuality were less frequent compared to other sexual behaviors, which can be related to the culture. Studies conducted in Asian countries, in line with the present study, have reported less occurrence of these behaviors among the Asian youth compared to their western counterparts (10, 27). Loss of virginity is a concern especially for girls in Asian cultures such as Iranian culture, and in many regions, it can lead to crisis in their life (28).
In this study, the third common sexual behavior among the students was sexting by the frequency of 9.7% in the direct method and 9.1% in the indirect method. Studies have shown that sending sexual images and texts is common among students, and those who have experienced this method previously have greater tendency to repeat it again (29). Other studies have reported relationships between sexting and other high-risk sexual behaviors, unprotected sexual behaviors, sexually-transmitted diseases, and drug abuse, furthermore, these individuals have frequently mentioned sending and receiving erotic images with the person with whom they have sexual relationships (30, 31). In another study, in line with the results of the present study, sexting has also been observed in males more than females (30). Easy access to cell phone and social media is one of the reasons for the prevalence of this behavior among students. Meanwhile, the constraints in dating in the Iranian culture can also promote this behavior among youth (28). In a study conducted in China, spending much time in internet and social networks was reported as an important cause of the incidence of sexual behaviors (10).
Prevalence of high-risk sexual behaviors especially during young ages, can lead to problems such as increased sexually-transmitted infections, unwanted pregnancies, and emergence of psychological and physical harms (28)
Interestingly, as the results of study showed both direct and indirect methods were adopted for discovering sexual behaviors, but direct positive responses between girls were significantly more frequent compared to indirect responses, which can indicate more secretiveness in sexual issues among girls, as the results showed the VF for most sexual behaviors in females was less than 1, while the opposite was true for male students. So, it seems female students do not share their sexual behaviors even with their close friends. On the other hand, as for male students, NSU estimated rates were higher. Two hypotheses are mentioned: one is the male students do not reply direct questions as honestly as female students, second they exaggerate risky behaviors in their network. Although premarital sexual relations of any kind are reprehended according to Iranian society, but it is considered more negative for girls rather than boys (19, 32).
As the results showed, sexual behaviors such as porn watching, masturbation and sexting exist more than other high-risk sexual behaviors in the young population, although in somehow hidden, which may be harm them, their family and society. So training should be given about high-risk sexual behaviors especially among the Iranian youth who live in a sexually restrained culture. Furthermore, the youth and adolescents should learn how to react to sexual issues, images and texts so that they would be less harmed. Training families about sexual issues of the youth and how establish effective communication with young children can enhance the sexual well-being of this group of the society.