BACKGROUND: This research constitutes a pioneering cross-sectional investigation into sexual behaviors within the Maltese population, centered on the examination of meaning of sex, sex frequency, sex duration, sexual satisfaction, and discussions about sex. AIM: The aim of this study is to explore how the Maltese define the term "sex" and with whom they discuss sexual matters while testing the hypotheses that the frequency and duration of sexual activity, as well as the discussion of sexual matters, influence sexual satisfaction. METHODS: Data were collected via a computer-assisted telephone interview method, using a randomized sample of 400 Maltese adults aged 18 and above. The questionnaire included 33 items addressing various aspects of sexual behavior. The responses were analyzed using SPSS, applying Mann-Whitney OUTCOMES: To gauge participants' sexual satisfaction, respondents were tasked with rating their contentment with their sexual lives on a scale from 1 to 5. RESULTS: Results revealed that 26.9% of respondents defined sex as a "sexual act between two persons," while 26.8% linked it to "an act of love." Few participants associated sex with pleasure or intimacy, reflecting possible conservative cultural influences. A majority (61.7%) felt comfortable discussing sexual matters with their partners, while only 26.6% were comfortable doing so with friends. The average sexual frequency was 5.69 times per month. Sexual satisfaction was positively correlated with frequency as individuals reporting more frequent sex were generally more satisfied with their sex lives. However, no significant association was found between the duration of sexual activity and sexual satisfaction. CLINICAL TRANSLATION: The study's clinical implications provide valuable insights for healthcare professionals, policymakers, and researchers grappling with sexual health concerns within the Maltese population. STRENGTHS AND LIMITATIONS: This pioneering study provides new insights into sexual behaviors in Malta, with stratified sampling enhancing the sample's representativeness. However, social desirability and recall bias may affect the accuracy of self-reported data, and the focus on age, gender, and relationship status overlooks other factors, such as cultural or religious influences, that may offer a deeper understanding of sexual behaviors. CONCLUSIONS: The Maltese population demonstrates a diverse understanding of "sex" while also revealing that most individuals feel comfortable discussing sexual matters with partners but not with friends
additionally, the population reports an average sexual frequency of 5 times per month, lasting between 26 and 45 minutes, with the majority expressing overall satisfaction with their sexual lives.