Sexual and reproductive health in Germany – Expatica Belguim

From contraception and pregnancy to cancer screenings and support services, we explain all you need to know about sexual health in Germany.

Fortunately for expats moving to Germany, the country boasts a reputable healthcare system that enables relatively easy access to sexual health services. Therefore, they can rest assured that they are in safe hands once they have set up their new life in the country.

That said, it can feel daunting to navigate all the medical channels in Germany; especially if you don’t speak German and face a language barrier. So, to help you get to grips with it, this guide covers all the basics of sexual and reproductive health in Germany, including the following:

Attitudes towards sex and sexuality in Germany

Compared to other countries worldwide and even throughout Europe, Germany has a reputation for being a ‘liberal’ nation when it comes to general attitudes towards sex and sexuality. In fact, it ranks highly as a sexually satisfied nation and has some of the most comprehensive sex-education programs in the world.

Luckily for those who call the country home, it also has a high-quality healthcare system, which offers easy access to a range of sexual health services. In fact, the World Health Organization (WHO) ranks it in 25th place out of 191 countries worldwide.

Accessing sexual health services in Germany

All foreigners living and working in Germany can access subsidized state healthcare, which covers a wide variety of sexual health services. However, before they can do so, they must have some form of health insurance. They can either register with a statutory German health insurance scheme (gesetzliche Krankenkasse – GVK) or a private insurance scheme (private Krankenversicherung – PVK).

While the vast majority of German workers remain on the German health insurance scheme, some expats choose to take out more extensive private health insurance. This can offer more extensive services and shorter waiting times. But regardless of whether you use a private or public scheme, German health insurance contributions are split between employers and employees.

Once you have insurance, you can access a vast network of practitioners that provide sexual health services throughout Germany. General practitioners can generally address basic issues and refer their patients to specialist doctors when necessary. They can also conduct HIV and STI tests and screenings.

Gynecologists also deal with many aspects of women’s health, including sexual health, and can carry out a wide range of consultations and procedures. Typically, all gynecologists will accept both private and public insurance and don’t require a referral from a doctor. You can simply call one up in your area or get a recommendation from a friend.

Local sexual health services

Aside from doctors, local pharmacies (Apotheken) can provide basic information and counseling regarding minor issues such as yeast infections or vaginal dryness. In this case, they may recommend over-the-counter remedies. Pharmacies also sell sexual health items such as condoms, pregnancy tests, and lubricants. Many drugstore chains in Germany also stock these items.

Meanwhile, various governmental and non-profit organizations such as ProFamilia provide consultations and assistance with sexual health issues, including birth control and AIDS. Liebesleben can also help you find services and practitioners through its website which has English navigation. The organization can also help those who don’t have German insurance find free or low-cost services. This includes things like neighborhood clinics that perform free HIV testing or provide free birth control counseling.

Insurance for sexual and reproductive healthcare

Notably, if you are an EU citizen and fall ill during a temporary stay in Germany, you can use your European Health Insurance Card (EHIC) to access urgent sexual healthcare. This should cover the costs of emergencies or problems, such as visiting a doctor to get treatment for a UTI. However, just bear in mind that your EHIC card will not cover specialized treatments or private care for sexual health matters in Germany.

Otherwise, all residents in Germany must have some form of health insurance, be it public or private. All German health insurance provides extensive coverage for many sexual health services. Therefore, you can rest assured that you are in safe hands.

Public versus private health insurance

Public insurance (gesetzliche Krankenkasse – GVK) is more common in Germany and covers most people in paid employment. It sometimes covers their family members too, as well as pensioners and the unemployed. Public insurance also covers many screenings and tests and generally takes care of services related to pregnancy, birth, and the postpartum period. It also can cover or subsidize some forms of birth control.

Private insurance (private Krankenversicherung – PVK), on the other hand, is less common and is typically required (or preferred) by certain higher earners. It is also available to those who prefer to have it, such as the self-employed or civil servants. While private health insurance has higher tariffs, it does have some key benefits. For instance, it may cover some – or all of – the costs of sexual health treatments that fall under the category of ‘alternative medicine’. This includes things like homeopathy and acupuncture. Therefore, if you think you might require this, it could be worth considering.

There are a number of private health insurance companies operating in Germany. These include large multinational insurers as well as local German providers, offering full and supplementary policies. German health insurance providers include:

You can compare private health insurance providers in Germany and get free quotes on our special health insurance page, and with tools such as GKV and PVK (in German).

Contraception in Germany

If you live in Germany, you will have access to a variety of contraceptive measures and education. This is partly why the country has high rates of contraceptive usage and a relatively low teenage pregnancy rate.

Here is a list of the various forms of contraception available in the country:

• The birth control pill – subsidized by all German health insurances, and is prescribed by a gynecoogist; a pack of pills costs approximately €20 for a 3-month supply
• Condoms – available in any drugstore, pharmacy, and sometimes grocery stores, costing approximately 50 cents per piece
• The copper IUD – costs between €130 and €450 for initial placement, as well as some partial costs for check-ups
• The hormonal IUD – costs between €300 and €400 for placement and partial costs for check-ups
• Birth control injections – these cost around €40 and are administered every 12 weeks
• The birth control implant – lasts up to three years and costs around €300
• The birth control ring – costs around €15 per piece
• Birth control plasters – cost around €15 per piece
• The diaphragm – costs about €50 euros, plus additional costs for spermicide
• Vasectomies and hysterectomies – these are surgical procedures and can cost between €500 and €1,000
• The morning after pill – available at all German pharmacies without a prescription

Family planning services

Germany is also home to an array of family planning services where sexual health practitioners, such as gynecologists, can offer consultations about contraceptive use. There are also various non-profit organizations, such as ProFamilia, that provide free or low-cost counseling.

Pregnancy and childbirth in Germany

Whether you opt for public or private health insurance, you can rest assured that you are in safe hands when it comes to having a baby in Germany. Both options will cover all visits to your gynecologist throughout your pregnancy. They will also cover the costs of a midwife (Hebamme) who can conduct a number of prenatal check-ups and perform postpartum house visits to check up on you and your baby.

However, while public insurance covers most standard procedures and the three major ultrasounds during pregnancy, it doesn’t cover all tests or ultrasounds. For instance, you will need to pay out of pocket for certain things like a toxoplasmosis test or NIPT screening. If you have private health insurance, you should check your pregnancy testing coverage with your provider beforehand.

Delivery options in Germany

There are three options for giving birth in Germany: in a hospital, in a birth center, or at home. For the latter options, you will need to have a low-risk pregnancy in order to gain approval from a midwife. Public insurance will cover a hospital stay, but not the costs for a private room. Some private insurance, on the other hand, may cover this.

Both public and private insurance will cover part of the costs of a birth center or home birth. However, you will typically need to make a token payment of between €300 and €600. Insurance will also cover the cost of a six-week postpartum check-up by a gynecologist.

Insurance will also cover visits from your Hebamme for approximately two to three weeks postpartum, and sometimes further visits for breastfeeding issues. However, you will need to pay a lactation consultant (Stillberater/in) yourself.

Notably, if you want to arrange private health insurance for your baby, you should contact your insurance provider while you are pregnant to sort out the paperwork beforehand.

Abortion in Germany

Abortion is somewhat of a complicated topic in Germany. Theoretically, it is illegal but permitted under certain circumstances. These include having an abortion in the first trimester after a mandatory counseling session, if the pregnancy was a result of sexual assault, or if the pregnancy could cause grievous harm to the woman’s mental or physical health.

Theoretically, a woman getting an abortion could encounter criminal prosecution, unless she fulfills certain legal criteria such as receiving abortion counseling and having the procedure performed by a medical professional. Typically, the first step is to talk to a trusted gynecologist or meet with a sexual health non-profit like ProFamilia.

Notably, there has been pushback in recent years regarding the legal status of abortion in Germany. While there have been many anti-abortion demonstrations across the country in recent years, there have also been public protests to make it completely legal. However, one major issue is the general lack of practitioners who have training in and are willing to perform the procedure in Germany.

STIs and STDs in Germany

Germany boasts relatively low STI and STD rates in the developed world and ranks among the lowest countries in Western Europe. The most common STIs and STDs in Germany are MGEN, chlamydia, and gonorrhea. There has been a slight rise in cases of syphilis in the last few years, but overall, this still remains low.

Your gynecologist, urologist, or Hausarzt (general practitioner) can test you for STIs and STDs, but you will most likely have to pay for this yourself. That said, you may be able to get the tests covered by insurance if there are symptoms. Alternatively, you can order at-home STI testing kits, which generally cost between €39 and €60. There are also some walk-in clinics throughout the country that provide low-cost or free testing.

If you test positive, you will need to seek treatment from a specialist or ask your Hausarzt to refer you to one. Generally, treatment will involve antibiotics or anti-parasite therapies, and most medications for STIs and STDs are covered by insurance.

HIV/AIDS in Germany

Germany has particularly low HIV/AIDS rates, which is largely thanks to excellent HIV/AIDS education, good access to contraception, and high-quality health services. Any Gesundheitsamt (public health service agency) will test you for free and anonymously. General practitioners can also perform HIV/AIDS tests. Additionally, HIV self-tests are available for purchase at Apotheken (pharmacies) or online.

Public health insurance covers HIV treatments and medications, but patients who are privately insured may only be able to access base-rate insurance policies if they have HIV. Therefore, not every treatment will be covered. There are many organizations in Germany that can help people living with HIV/AIDS. And currently, there are no travel restrictions for anyone with HIV/AIDS planning to enter Germany.

Erectile dysfunction treatment in Germany

If you are experiencing issues with erectile dysfunction, the first place to seek help is from your general practitioner (Hausarzt). They can prescribe medication for erectile dysfunction, or refer you to a specialist if required.

Some treatments in Germany include medication, an implant, vacuum therapy, and psychotherapy. Some of these may be covered by public or private insurance, but you should talk to both your doctor and your insurance provider about the costs beforehand.

Feminine hygiene products in Germany

Germany offers a wide arrange of feminine hygiene products, which are available in drugstores or the local Apotheke (pharmacy). Products for purchase include tampons and disposable pads, menstrual cups, cloth pads, and period underwear.

As of 2020, Germany has done away with the luxury tax on feminine hygiene products. The cost of these items has theoretically dropped since then. Insurance doesn’t cover the costs of feminine hygiene products in Germany; therefore, it might be worth looking into reusable options like menstrual cups or cloth pads. Not only do reusable options save money, but they are also more environmentally friendly.

Cancer screenings in Germany

Germany ranks in 15th place among countries with the 50 highest cancer rates in the world, accounting for 313.1 per 100,000 people. According to data, there were 628,519 new cases in 2020, affecting the breast (69,697), prostate (67,959), lung (64,804), colon (57,528), and bladder (35,147).

Germany instituted a National Cancer Prevention Week in 2019 to raise awareness about various types of cancer. Additionally, many individual institutions for specific cancers place billboards or awareness posters throughout the country at various times of the year.

How to get screened for cervical cancer

A gynecologist will typically conduct a screening for cervical cancer on a yearly basis starting at age 20. The scientific committee Ständige Impfkommission (STIKO) recommends that boys and girls between the ages of 9 and 14 have the HPV vaccine. The vaccine is covered by all insurances in Germany and is administered by a child’s Kinderarzt (pediatrician).

Screening for breast cancer

Breast cancer is the most common form of women’s cancer in Germany, but only 1% of cases involve men. Gynecologists offer women aged 30 and up an annual palpation check-up, which all insurance covers. Women aged 50 and up are eligible for an annual mammogram, which is performed by a gynecologist and is also covered by all health insurance.

However, there is no specific screening process for men. If you are male and concerned that you may have breast cancer, the first thing you should do is consult your Hausarzt. If you are considered to be high risk and have a family history of breast cancer, you should talk to a gynecologist about additional screening possibilities.

Screening for ovarian cancer

There are approximately 7,300 deaths a year from ovarian cancer in Germany. Tragically, ovarian cancer is usually only discovered in its later stages. Screenings for ovarian cancer in Germany are relatively rare, and typically only carried out if there are symptoms or specific concerns. However, if there is a legitimate concern about ovarian cancer, then both public and private insurance will cover the screening costs.

Screening for prostate cancer

Annually, there are around 60,000 prostate cancer diagnoses and approximately 12,000-14,000 deaths from the disease in Germany. For men aged 45 and up, all insurance covers the cost of a ‘basic’ rectal screening. However, for a more advanced prostate cancer screening, you will typically have to pay for this yourself. That said, it may be possible to get some of the screening costs reimbursed by insurance. You should talk to your Hausarzt or a urologist about this directly.

Screening for testicular cancer

There are around 4000 cases of testicular cancer per year in Germany. As of now, the only testicular cancer screening in Germany is a general check-up of the genitals and prostate for men aged 45 and older. However, if you have concerns about testicular cancer, you can consult your Hausarzt about arranging additional exams and testing.

Screening for penile cancer

Penile cancer is relatively rare in Germany, with less than 950 diagnosed cases per year. There is currently no specific screening for penile cancer within the German healthcare system. Men aged 45 and above are entitled to an annual digital screening of their genitals and prostate. At this screening, the doctor (typically your Hausarzt or general practitioner) will also briefly check for any concerning symptoms that might indicate the possibility of penile cancer.

Services dealing with sexual problems in Germany

Germany has a wide variety of services if you are dealing with sexual problems; ranging from vaginismus to issues having an orgasm. For some issues such as vaginal dryness, you may even be able to get some over-the-counter advice and product recommendations at your local Apotheke (pharmacy). However, if the problem is more severe, you should consult your gynecologist, urologist, or general practitioner.

When it comes to sexual issues that are a combination of physical and psychological, or purely psychological, there are a few types of resources that you can turn to. For instance, there are a number of non-profit organizations, such as Pro Familia, that offer counseling.

If you need or want to see a sex therapist, you will typically need an Uberweisung (a written referral) from your gynecologist or urologist, or sometimes your general practitioner. Whether you have public or private health insurance, you should check to see how many sessions it will cover and the length of treatment.

Services dealing with sexual abuse and assault in Germany

When a person experiences sexual assault or rape in Germany, the assailant is subject to criminal law. In the event that someone experiences bodily harm, the person is also entitled to victim’s compensation; as per the Victims Compensation Act (Opferentschädigungsgesetz – OEG).

Germany has a free telephone hotline for violence against women called the Hilfetelefon Gewalt gegen Frauen. It offers 24/7 assistance in 17 languages including English. There is also a database (available in English) where you can find free counseling services for sexual assault throughout the country.

Both the victim of a sexual assault and any witnesses can file a criminal complaint. When physical evidence of the crime exists, the police will typically want to use it as part of the case. If a victim sees a doctor after the assault, that can also become part of the evidence.

Young people’s sexual health in Germany

Since 1992, sex education has been mandatory in German schools. However, the age at which sex education starts can range from one Bundesland (federal state) to another. Topics typically include sexual reproduction, STDs, and general sexual health. Sex education continues on into puberty as children exit Grundschule (elementary school).

Older children and teenagers learn about sex and sexuality in a more in-depth fashion as they progress through their school years. Along the way, they will learn about healthy relationships, consensual sex, LGBT+ sexuality, and contraception. This may come as a bit of a shock to parents from more conservative countries, however, it has a positive payoff. For instance, teenage pregnancy rates in Germany are fairly low, especially when compared to other European countries.

Germany also has lower rates of adolescent STD infections compared to many other Western countries. This is partly due to easy access to contraception among adolescents, as well as a societal acceptance of safe sexual activity among consenting partners.

Overall, sexual health for young people in Germany is quite good, and as a parent, this can be reassuring to hear.

Sexual health service for youth in Germany

Besides having sex education at school, youngsters in Germany have access to a range of sexual health services, many of which are confidential. Organizations such as Condrobs and Pro Familia can provide counseling to teenagers. Here, they can speak to a professional about their sexual questions or concerns, as well as seek advice about contraception. Additionally, many gynecologists and urologists, as well as Kinderarzte (pediatricians) can provide advice and counseling to minors regarding their sexual health and safety. This is also covered by all health insurance.

LGBT+ sexual health in Germany

Same-sex and LGBT+ relationships are socially accepted in most of German society. Gay marriage was legalized in 2017, and while Germany is still a bit more conservative when it comes to the LGBT+ community than, say, the Netherlands, many people who identify as LGBT+ feel welcome and at home while living there. It is also illegal to discriminate against someone for their sexual identity in Germany. Furthermore, there are certain cases of asylum in Germany due to LGBT+ identity. This includes refugees from countries where homosexuality is illegal.

Any member of the LGBT+ community is entitled to the same level of medical care and legal protections as any other German resident. However, resources and service centers that specifically cater to the community are primarily in major cities. Some examples of these include Checkpoint BLN in Berlin and Lesbisch-Queeres Zentrum Munchen in Munich. In addition to providing sexual health services and counseling, the centers can be an excellent resource for community building.

Useful resources

• STIKO (Robert Koch Institute) – the official website of the German commission on vaccines, with information in German and English
• Liebesleben – offers resources on sexual health in Germany, including search portals to help you find professional consultations
• BZGA – the Federal Center for Health Education in Germany, which provides information on sexual health, women’s health, and vaccines
• Pro Familia – offers resources about sexual health for youth and adults
• Frauen Gegen Gewalt – provides information and links to resources about sexual violence against women in Germany
• Queer Refugees Welcome – provides information about LGBT+ asylum, HIV/AIDS, and LGBT+ rights in Germany
• STI-Clinic Berlin – one of the biggest STD/STI clinics in Germany

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