Regulation of Sexual Behavior and Health in German Prisons and Forensic Psychiatric Hospitals.

Individuals housed in prisons or forensic hospitals experience significant restrictions on their sexual rights. There is a lack of data on how sexual behavior and sexual health of institutionalized persons are managed and to what extent they are based on shared guidelines or decisions of the individual staff. Using a standardized online questionnaire, the heads of 35 prisons and 32 forensic psychiatric hospitals across 14 German federal states were surveyed, reflecting the situation of 16,902 inmates and patients. The findings reveal an absence of shared guidelines as well as an institution-specific approach to sexual behavior and sexual health. Exploratory multiple linear regression identified four variables that predict differences in the regulation of individual's sexual behavior and sexual health: type of institution (prison or forensic hospital), percentage of institutionalized sex offenders, number of housed individuals, and an item concerning the sexuality-related attitudes of the respondent. Respondents, particularly in the field of forensic psychiatry, expressed a general desire for guidelines. Our study shows that possibilities for sexual expression and sexual health vary strongly, depending on the institution. Therefore, it appears useful and desirable to develop guidelines on how to regulate sexual behavior and sexual health of institutionalized individuals.