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Do swingers self-identify as swingers when attending STI services for testing? A cross-sectional study
  1. Laura W L Spauwen1,
  2. Anne-Marie Niekamp1,2,
  3. Christian J P A Hoebe1,2,
  4. Nicole H T M Dukers-Muijrers1,2
  1. 1 Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Services, Heerlen, The Netherlands
  2. 2 Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
  1. Correspondence to Dr Nicole H T M Dukers-Muijrers, Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen 6160HA, The Netherlands; nicole.dukers{at}


Objectives Swingers, that is, members of a heterosexual couple who, as a couple, had sex with other couples and/or singles within the swinger’s subculture, are a hidden population with substantial rates of sexually transmitted infections (STIs) and high-risk sexual behaviour. Information on swingers’ self-identification to be a swinger, their risk perception and attitudes about STI testing and safe sex will help to reveal swingers who are hidden while in care, to address them with targeted strategies.

Methods We used data from a convenience sample of 289 swingers from our Dutch STI clinic patient registry between 2009 and 2012 (median age 45 years; 49% women; STI positivity 13%, no condom in vaginal sex: 57%). Participants filled in a self-administered questionnaire on sexual behaviour and answered statements about self-identification, risk perception and attitudes about STI testing and safe sex.

Results Of all participating registered swingers, 56% self-identified as a swinger. Safe sex was reportedly deemed important (77%). Overall, 72%, 62% and 56% reported that STI testing, partner notification and condom use is the norm in the swinger community. The latter was reported more often by self-identified swingers compared with non–self-identified swingers. Self-identified swingers further swinged more often, had more partners and more often swinged at home parties than non–self-identified swingers.

Conclusions About half of STI clinic attending swingers whose sexual behaviour agrees with the definition of swinging are neutral/do not identify themselves to be a swinger. As many STI clinics internationally not specifically ask clients about their swinging behaviour, swingers may be a missed target population in care. Implementation of routine questions addressing behaviour (thus not only asking whether someone is a swinger) in STI clinics is feasible and facilitated by swingers’ positive norm towards STI prevention and testing. Implementing routine swinger questions contribute to effective STI services including appropriate testing, counselling and partner notification.

  • chlamydia trachomatis
  • heterosexual behaviour
  • sexual behaviour
  • neisseria gonorrhoea
  • public health

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  • Handling editor Jackie A Cassell

  • Contributors LWLS analysed the data and drafted the manuscript. NHTMDM drafted the manuscript and supervised the study. AMN was involved in the data collection. AMN and CJPAH contributed to revising the draft critically for important intellectual content. All authors substantially contributed to the conception or design of the work and to the acquisition, analysis or interpretation of data. All authors provided final approval of the version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Medical Ethical Committee of Maastricht University Medical Centre.

  • Provenance and peer review Not commissioned; externally peer reviewed.