Institute for Global Health


The National Surveys of Sexual Attitudes and Lifestyles (Natsal)

The National Surveys of Sexual Attitudes and Lifestyles (Natsal) are the world’s largest, most detailed studies of sexual behaviour.


Dates: Late 1980s - 01/02/2024

Principal Investigator: Cath Mercer/Pam Sonnenberg

Partners: NatCen Social Research, London School of Hygiene & Tropical Medicine, University of Glasgow, WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University (Sweden)

Location: UK

Funding: The Natsal Resource is supported by a grant from the Wellcome Trust (212931/Z/18/Z), with contributions from the Economic and Social Research Council and the National Institute of Health Research.

Contact: Dr Cath Mercer (c.mercer@ucl.ac.uk); Prof Pam Sonnenberg (p.sonnenberg@ucl.ac.uk)

Project Summary

The National Surveys of Sexual Attitudes and Lifestyles (Natsal) are the world’s largest, most detailed studies of sexual behaviour. People are randomly selected, based on their postcodes, and invited to participate, so the surveys represent the general population in Britain. 

Natsal has taken place roughly every 10 years (1990/’91, 1999-2001, 2010-‘12) with a fourth survey planned for 2021. Interviewers will collect information from nearly 10,000 people aged 15-59 using computerised questionnaires to ensure privacy. Survey answers will be combined with information from biological samples (e.g. urine to test for sexually transmitted infections) and routinely-collected data (e.g. health records). 

By combining Natsals, we will create a resource that provides a comprehensive picture of the sexual health of the nation and show how this has changed over time and across generations. The findings will guide policy on services and interventions to improve sexual health in Britain. Examples of Natsal’s impact to date include:

  • Natsal data have been used to plan services, including evaluating progress towards targets outlined in national strategies, (e.g. the Teenage Pregnancy Strategy) and modelling the effects of HPV vaccination. 
  • Natsal has demonstrated population-based increases in uptake of chlamydia screening, HIV testing, and sexual health service use, and continues to be used to estimate HIV prevalence and undiagnosed HIV in the population.
  • Natsal has informed policy debates, including being extensively cited in the House of Commons Education Select Committee Inquiry into Personal, Social, Health, and Economic Education and more recently as a submission to the 2018 Health and Social Care Committee's Inquiry into Sexual Health. 
  • Data from Natsal have provided the scientific justification for the revised severity criteria for diagnosis of sexual dysfunction in DSM-5. 

Natsal has also played an important role in the public dialogue about sex, has advanced science, and built research capacity. Natsal was a well-received Impact Statement in the 2014 Research Excellence Framework and was selected as one of 14 case studies at the Wellcome Trust 75th anniversary celebrations.

Research Team
Dr Cath Mercer
Dr Pam Sonnenberg
Dr Rob Aldridge
Prof Chris Bonell (LSHTM)
Soazig Clifton (NatCen/UCL)
Dr Andrew Copas
Dr Nigel Field
Dr Jo Gibbs
Wendy Macdowall (LSHTM)
Dr Kirstin Mitchell (University of Glasgow)
Gillian Prior (NatCen)
Dr Clare Tanton (LSHTM)
Prof Nick Thomson (LSHTM)
Magnus Unemo (WHO Collaborating Centre for Gonorrhoea and Other STIs/Örebro University)




Sexual Health
Population Health
Sexually Transmitted Infections (STI)


Further research