[Assessment and operationalization of the characteristic "gender" in representative population-based surveys: challenges and implications with the example of the GeSiD study]. / Erfassung und Operationalisierung des Merkmals "Geschlecht" in repräsentativen Bevölkerungsstichproben: Herausforderungen und Implikationen am Beispiel der GeSiD-Studie.

Representative quantitative surveys assess the participants' gender in order to allow for gender specific analyses of the research questions and to draw conclusions about the populations. This is important in order to develop information and interventions tailored to the target groups. However, although gender is no longer considered exclusively as a binary construct, it is still often surveyed through a binary variable with the response options woman/man or female/male. In this article, we discuss why this approach is outdated or incomplete and why a move away from this approach is important and necessary. Using the GeSiD study on "Health and Sexuality in Germany" as an example, in this discussion post we demonstrate how gender can be assessed by means of a two-step model in which the first step assesses gender assigned at birth and the second step the subjective gender affiliation. At the same time, we discuss the challenges that this approach brings along. We place the results of the GeSiD study into a larger context and discuss the implications and possibilities for operationalizing gender in representative surveys.

Health, Sexual Activity, and Sexual Satisfaction.

BACKGROUND: Physical and mental health disorders can markedly affect sexual activity and sexual satisfaction. Until now, there has been a lack of representative data from the German population that could serve as a basis for demonstrating specific links between sexuality and health. METHODS: In the German Health and Sexuality Survey (GeSiD), 4955 men and women in a two-step stratified random sample drawn from local resident registration offices across Germany were surveyed by questionnaire. The response rate was 30.2%. The questions involved, among other things, the respondents' selfassessment of sexual activity and sexual satisfaction, general health status, and any chronic illnesses or disabilities. RESULTS: The percentage of respondents who reported having been sexually active with one partner in the past four weeks was highest among men aged 36 to 45 and women aged 26 to 35. In male respondents, the likelyhood of having been sexually active in the past four weeks decreased from 79.1% to 59.0% and 30.1%, respec - tively, if they described their own health status as fair or bad compared with those in very good health. In female respondents the decrease was from 72.5 % to 48.0 % and 32.4%, respectively. A comparable association was found with self-reported chronic illnesses and disabilities that were perceived as impairing sexuality. Sexual satisfaction was present to a similar extent in all age groups. CONCLUSION: Self-reported physical and mental illnesses are often associated with marked impairment of sexuality. Even illnesses without any immediately evident relation to sexuality often affect aspects of sexual health. It is, therefore, advisable for physicians to address their patients' sexuality routinely in everyday clinical practice.