Sexual Behaviour and Masturbation Practices: Impacts on Psychological well-being among tertiary students in Ghana

Risky sexual behaviours and masturbation are significant public health concerns and are linked to negative physical effects and psychological outcomes, posing challenges to achieving Sustainable Development Goal, particularly goals 3 (Good Health and Well-being) and 5 (Gender Equality). The study’s primary aim was to determine the prevalence of Masturbation Practices, Sexual Behaviour, and its effect on psychological Well-Being Among Tertiary Students in Ghana. This cross-sectional study employed multistage sampling, and data were collected using structured questionnaires and standardised tool (DASS-21) administered through the Kobocollect toolbox. The study was underpinned by Problem-behaviour Theory (PBT). Primary outcomes included masturbation, risky sexual behaviour, and psychological well-being (measured with validated DASS-21 cut-offs). Subscale scores were summed, multiplied by two, and classified using validated cut-offs to categorize participants into “good” or “poor” mental health. Data were analysed using STATA v17, employing both descriptive and inferential statistical methods. Of the 1,684 students surveyed, 1,280 (76%) reported high-risk sexual behaviours, 1,002 (59.5%) had ever engaged in masturbation, and 955 (56.7%) reported poor mental health. Physical effects after masturbation included genital swelling (64.4%), skin irritation (59.0%), and pelvic pain (44.7%), while female-specific effects included vaginal dryness (26.2%) and vaginal discharge (23.3%). Students who practiced masturbation were 10 times more likely to engage in high-risk sexual behaviours compared to those who did not (aOR = 10.0, 95% CI: 3.4–11.9, p < 0.001). Similarly, students who consumed alcohol were 5 times more likely to engage in high-risk sexual behaviours (aOR = 5.1, 95% CI: 1.3–6.8, p = 0.002). Those who viewed pornography were 15 times more likely to engage in high-risk sexual behaviour (aOR = 15.0, 95% CI: 3.3–16.6, p < 0.001). Masturbation practice was significantly associated with poorer mental health, as students who engaged in masturbation were 39% less likely to have good mental health compared to those who did not (aOR = 0.61, 95% CI: 0.31–0.72, p = 0.001). Students who reported experiencing any physical effects after masturbation had over 12 times more likely to report poor mental health (aOR = 12.3, 95% CI: 6.1–14.3, p < 0.001). Also, those who experienced pain during urination were 40% less likely to have good mental health (aOR = 0.60, 95% CI: 0.45–0.91, p = 0.002). Risky sexual behaviours, high rates of masturbation with associated physical and mental health effects, and relationship challenges were common among students. Alcohol use and pornography strongly predicted unsafe sexual practices. These findings highlight the need for the Ministry of Health and the Ghana Education Service to provide comprehensive sexual health education and counselling services in tertiary institutions. Addressing these issues contributes to SDG 3 (Good Health and Well-being) by reducing sexual health risks and improving mental well-being.