A Population-based Survey of Sexual Activity, Sexual Problems and Associated Help-seeking Behavior Patterns in Mature Adults in the United States of America

E.O. Laumann; D.B. Glasser; R.C.S. Neves; E.D. Moreira Jr.

Disclosures

Int J Impot Res. 2009;21(2) 

In This Article

Results

Characteristics of the Study Population

Overall, 19 377 individuals in the United States were contacted, 2817 of whom were not eligible to participate. Of the 16 560 eligible individuals, a total of 1491 individuals (742 men and 749 women) completed the survey, for a response rate of 9.0%. The high attrition rate is, in part, attributable to the protocol which stipulated that in the interest of preserving respondents' anonymity, no call backs were permitted to find better times for interviews or to try to persuade 'refusers' to participate.

Table 1 presents selected characteristics of the study sample. A large proportion of the subjects were married or involved in an ongoing partnership (64.8% of men and 62.0% of women). The majority of the men (61.0%) and women (68.5%) were employed and, overall, about 75% of men and women reported that they were in good or excellent general health.

Approximately 80% of men and 70% of women said that they had had sexual intercourse during the 12 months preceding the interview, whereas about one-third of men (35.4%) and more than one-quarter of women (27.8%) engaged in sexual intercourse regularly (that is, more than once a week).

Prevalence of Sexual Problems

Early ejaculation was the most common male sexual problem, and was reported by 26.2% of the sexually active men in the United States (approximately half of whom said that they experienced this problem periodically or frequently) (Table 2). Erectile difficulty was the second most common male sexual problem in the US sample, reported by 22.5% of sexually active men (12.4% said that they experienced this problem periodically or frequently), followed by a lack of sexual interest, which was reported by 18.1% of sexually active men (8.1% said that they experienced this problem periodically or frequently). The other sexual problems investigated (an inability to reach orgasm, a lack of sexual pleasure and pain during sexual intercourse) were experienced somewhat less frequently, particularly pain during intercourse, which was reported by only 3.1% of sexually active men in the United States.

Lack of sexual interest (33.2%) was the most common sexual problem reported by sexually active women in the United States, followed by difficulty becoming adequately lubricated (21.5%), an inability to reach orgasm (20.7%) and a lack of sexual pleasure (19.7%) (Table 2). At least one-half of the women who reported each of these problems said that she experienced it frequently or periodically. The other sexual problem investigated was pain during sexual intercourse, which was experienced by 12.7% of sexually active women.

Physical/health, demographic and socioeconomic factors associated with three selected sexual dysfunctions in men and women are summarized in Table 3 (odds ratios (OR) from logistic regression). Older age (age 60-80 years compared with the referent age of 40-49 years) was a significant correlate of erectile difficulties in men (OR 2.19, P≤0.05) and lubrication difficulties in women (OR 2.56, P≤0.01), whereas the age range of 50-59 years (the age at which many women experience the menopause) was associated with an inability to reach orgasm in women (OR 2.45 compared with the referent of 40-49 years, P≤0.05). A lower than average level of physical activity was a significant correlate of lack of sexual interest in both men (OR 2.13, P≤0.05) and women (OR 1.76, P≤0.05). The impact of a diagnosis of a number of common health conditions were investigated and it was observed that depression was significantly associated with a lack of sexual interest in both men (OR 3.19, P≤0.01) and women (OR 2.08, P≤0.01), erectile difficulties in men (OR 2.61, P≤0.01) and lubrication difficulties (OR 2.42, P≤0.01) and an inability to reach orgasm (OR 2.73, P≤0.01) in women. Among men, a diagnosis of prostate disease was associated with a lack of sexual interest (OR 2.56, P≤0.05).

Help-seeking Behavior

The prevalence of selected help-seeking behaviors for sexual problems in the United States is summarized in Table 4. Of the respondents who were sexually active and reported experiencing at least one sexual problem, 45.2% of men and 43.9% of women did not take any action (that is, they had not sought any help or advice). A slightly greater proportion of men (21.9%) than women (16.1%) reported talking to a medical doctor about their sexual problem(s), but overall the majority of men (75.7%) and women (79.7%) had sought no help from a health professional. Patterns of help-seeking behaviors were generally similar for men and women in the United States and talking to their partner was the most usual action taken by both men and women (43.3 and 43.4%, respectively).

Factors Associated with Seeking Medical Help for Sexual Problems

Some factors that might be associated with seeking medical help for sexual problems were investigated using logistic regression and the findings for both men and women in the United States are summarized in Table 5. A significant effect of age was seen only in men at age 60-69 years (OR 5.2, P≤0.01), compared with the referent group aged 40-49 years. Certain sexual problems were associated with a greater likelihood of seeking medical help. Erectile difficulties in men (OR 5.29, P≤0.001) and lubrication difficulties in women (OR 2.09, P≤0.05) were significant correlates of seeking medical help for sexual problems. A number of sexual beliefs and attitudes were significant correlates of seeking medical help for sexual problems. In men, these were 'being very or somewhat dissatisfied with their own sexual functioning' (OR 2.94, P≤0.01), 'a belief that decreased sexual ability would significantly affect their own self-esteem' (OR 2.69, P≤0.05) and 'thinking that it is acceptable to use medical treatment for sexual problems' (OR 13.52, P≤0.01). In women, having been asked by a doctor about possible sexual difficulties during a routine visit in the past 3 years (OR 2.23, P≤0.05), and thinking that a doctor should routinely ask patients about sexual function (OR 3.55, P≤0.05) were significantly correlated with seeking medical help for sexual problems. Thinking that older people no longer want/have sex had quite a different effect for men and women. Although among women, this belief was associated with an increasing likelihood of seeking medical help for sexual problems (OR 3.14, P≤0.01), men with this belief were less likely to seek medical help (OR 0.36, P≤0.05).

Attitudes and Beliefs About Diagnosis and Treatment of Sexual Problems

The most common reasons cited among respondents in the United States for not consulting a doctor about a sexual problem were thinking it was not very serious or waiting for the problem to go away (36.3% of men and 38.1% of women) and a belief that it is a normal part of aging or being comfortable as he/she is (25.4% of men and 28.2% of women) (Table 6). Lack of access to or affordability of medical care and embarrassment about discussing sexual problems with their medical doctor were cited as a reason by less than 5% of men and women, whereas a lack of belief that a sexual problem is a treatable medical condition was cited by about 15% of men and women. Few respondents in the United States had been asked by a doctor about possible sexual difficulties during a routine visit in the past 3 years (11.5% of men and 15.0% of women) but more than one-half of men (59.2%) and women (54.0%) thought that a doctor should routinely ask patients about their sexual function.

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