Background Evidence for relationships between alcohol misuse, sexual risk behaviour and adverse sexual health outcomes exists from both population-level data and studies undertaken in specific groups. We examine changes in these associations using representative data from two consecutive surveys.Methods Probability surveys conducted in 1990/91 and again in 2000/01 involving interviews with British residents aged 16-44.Results The proportion reporting being drunk as their main reason for first heterosexual intercourse increased from 2.5% among those born in 1946-49 to 6.4% of those born in 1980-84. These respondents were more likely to report intercourse before 16, that sex had occurred too soon, and contraception non-use. Usual alcohol consumption in excess of recommended limits ('heavy drinkers') was more common among those reporting larger partner numbers and unprotected sex with 2+ partners/past year but not with STD clinic attendance/diagnosis. Male heavy drinkers were more likely to report sexual function problems and female heavy drinkers using emergency contraception. The magnitude of these relationships did not significantly increase between 1990/91 and 2000/01.Conclusion In Britain, sexual risk behaviours and some adverse sexual health outcomes continue to be associated with excess alcohol consumption. These findings support addressing the link between alcohol misuse and sexual health in health services and through broader health promotion.