Sexual behavior and sexual health management in German prisons and forensic psychiatric hospitals lacks shared guidelines and instead relies on institution-specific approaches, with strong variation depending on institution type, proportion of sex offenders, institution size, and staff attitudes.
Key Findings
Results
There is an absence of shared guidelines for managing sexual behavior and sexual health across German prisons and forensic psychiatric hospitals.
Survey covered heads of 35 prisons and 32 forensic psychiatric hospitals across 14 German federal states.
The total population reflected was 16,902 inmates and patients.
An institution-specific approach rather than standardized policy was found to be the norm.
Respondents, particularly in forensic psychiatry, expressed a general desire for guidelines.
Results
Four variables were identified as predictors of differences in the regulation of sexual behavior and sexual health across institutions.
The four predictor variables identified via exploratory multiple linear regression were: 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.
These variables were identified through exploratory multiple linear regression analysis.
Staff attitudes toward sexuality emerged as an independent predictor of institutional regulation practices.
Results
Possibilities for sexual expression and sexual health vary strongly depending on the institution.
Both prisons and forensic psychiatric hospitals were included in the analysis, representing distinct institutional types.
The type of institution (prison vs. forensic psychiatric hospital) was one of the four significant predictors of variation.
The variation was not explained by a single factor but by a combination of institutional and attitudinal variables.
Background
Individuals housed in prisons or forensic hospitals experience significant restrictions on their sexual rights.
The study used a standardized online questionnaire administered to institutional heads.
The study covered 14 of Germany's federal states.
The lack of shared guidelines means that restrictions on sexual rights are determined at the individual institution level rather than through consistent policy.
Results
The respondents, particularly in forensic psychiatry, expressed a general desire for guidelines on managing sexual behavior and sexual health.
This desire was noted specifically among forensic psychiatric hospital respondents more than prison respondents.
The finding supports the authors' conclusion that it is 'useful and desirable to develop guidelines on how to regulate sexual behavior and sexual health of institutionalized individuals.'
The expressed need for guidelines aligns with the documented absence of shared protocols.
What This Means
This research surveyed the heads of 35 prisons and 32 forensic psychiatric hospitals across Germany, covering more than 16,900 incarcerated individuals and psychiatric patients, to understand how these institutions manage the sexual behavior and sexual health of people in their care. The study found that there are no shared national or regional guidelines governing these issues. Instead, each institution makes its own decisions, meaning that what sexual expression is permitted and what sexual health services are available depends heavily on where a person happens to be housed.
The study identified four factors that predict how strictly or permissively an institution regulates sexuality: whether it is a prison or a forensic psychiatric hospital, the proportion of residents who are sex offenders, the size of the institution, and the personal attitudes of the staff member completing the survey. The fact that individual staff attitudes are a significant predictor suggests that personal biases, rather than consistent policy, are influencing how sexual rights are handled for thousands of people.
This research suggests that the current lack of standardized guidelines leads to unequal treatment of incarcerated and institutionalized individuals with respect to their sexual rights and health care. The respondents themselves — especially those working in forensic psychiatry — expressed a desire for clearer guidelines. The authors argue that developing consistent standards for how sexual behavior and sexual health are managed in these settings would be both useful and necessary to ensure more equitable treatment.
Hanss H, Bründl S, Krasnova M, Fuss J. (2025). Regulation of Sexual Behavior and Health in German Prisons and Forensic Psychiatric Hospitals.. Behavioral sciences & the law. https://doi.org/10.1002/bsl.2711