Factors associated with lifetime use of commercial sex work services among Japanese men aged 20-49: findings from a quasi-representative national survey, 2022

Objectives: Approximately half of Japanese men aged 20-49 years have purchased sexual services, but data concerning the use of commercial sex work (CSW) in Japan remain scarce.

Methods: We used online survey data from the National Inventory of Japanese Sexual Behavior conducted in 2022 (N=4000 Japanese men aged 20-49 years). We calculated the median number of paid sexual partners over the lifetime. We performed logistic regression analysis to determine the sociodemographic, anthropometric and attitudinal factors associated with any lifetime CSW use among men in Japan.

Results: The median number of paid sexual partners reported among men who had ever used CSW was 6 (IQR 3-17) across the lifetime; the corresponding value for those who had ever used CSW in the past year was 2 (IQR 1-4) over the last 12 months. In general, those reporting lifetime use of CSW were significantly more likely than their CSW-naïve counterparts to be older, be married, be heterosexual or bisexual, have higher income and have higher education. Those reporting higher self-rated attractiveness, high or low satisfaction with their sex lives, a desire to increase their frequency of sex and considering sex to be an important aspect of their lives were also found to have a higher likelihood of having used CSW.

Conclusions: High rates of CSW use in Japan likely reflect ease of access, low stigma with respect to use of sexual services and the diversity in the type of services offered. High-income, employed older men have more financial resources at their disposal to purchase services, which can be cost-prohibitive for part-time or unemployed young men with low incomes. These findings will serve as a launchpad for public health efforts directed at promoting safe sexual practices and improved sexually transmitted infection screening rates among users of CSW in Japan.