With few exceptions every month uncovers more evidence of the declining sexual health of the UK population.^1,2 Levels of chlamydia have more than doubled in the past 10 years,¹ nearly forgotten infections such as syphilis have returned to plague new generations³ and overall, sexually transmitted infections (STIs) are higher than at any time since the National Health Service began in 1948.⁴ Furthermore, while some reductions have been made in teenage pregnancy rates, these have been modest and still leave the UK with one of the highest rates in Europe.⁵ By and large our attempts to avoid a sexual health crisis and, more recently, to manage it have failed.

At the core of this crisis is an unwillingness to engage with the “promiscuous” 10%; a significant group of people who have multiple sexual partners, may have started sex early in life, and may even access paid sex and pornography. For instance, one in ten young people have had sex at 14 or younger.⁶ Such individuals who have sex at an earlier age are less likely to use condoms at sexual initiation, are more likely to become pregnant earlier,⁶ and accumulate more sexual partners per year.⁷ Changing their behaviour is central to improving sexual health but these individuals are rarely the principal consideration when developing interventions. For instance, school based sex education is the main source of information on sex issues for young people.⁶ Evidence suggests that early sex education does not encourage early sexual activity⁸ but is central to young people obtaining appropriate information on sex, sexual health and relationships along with the skills required to manage these.⁹ However, …