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Despite the aging of the population, little is known about the sexual behaviors and sexual function of older people. We report the prevalence of sexual activity, behaviors, and problems in a national probability sample of U. The unweighted survey response rate for this probability sample was Among respondents who were sexually active, about half of both men and women reported at least one bothersome sexual problem.
Fourteen percent of all men reported using medication or supplements to improve sexual function. Men and women who rated their health as being poor were less likely to be sexually active and, among respondents who were sexually active, were more likely to report sexual problems. Many older adults are sexually active. Women are less likely than men to have a spousal or other intimate relationship and to be sexually active.
Sexual problems are frequent among older adults, but these problems are infrequently discussed with physicians.
Little is known about sexuality among older persons in the United States, despite the aging of the population. Sexuality encompasses partnership, activity, behavior, attitudes, and function.
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Driven in part by the availability of drugs to treat erectile dysfunction, the demand for medical attention and services relating to sexual health is increasing. Yet there is limited information on sexual behavior among older adults and how sexual activities change with aging and illness.
Limited data have indicated that some women and men maintain sexual and intimate relationships and desire throughout their lives, 246 — 8 but these data derive primarily from studies that are small, do not include very old persons, and rely on convenience samples. Physiologic changes can affect the sexual response of men and women and may inhibit or enhance sexual function as people age. Age and poor health are negatively associated with many aspects of sexuality. Blacks, Hispanics, men, and the oldest persons 75 to 84 years of age at the time of screening were oversampled.
Of eligible persons, women and men were successfully interviewed, yielding an unweighted response rate of During these visits, anthropometric measurements were performed; blood, salivary, and vaginal mucosal specimens were obtained, and physical function and sensory function were assessed. A complete marital and cohabiting history was obtained, with information on the timing of up to three most recent sexual partnerships within the 5 years.
Data with regard to the most recent sexual partnership are reported here. All respondents who had not had sex in the 3 months were asked to indicate why from a list of possible reasons. Sexually active respondents were asked about the presence of several sexual problems involving interest, arousal, orgasm, pain, and satisfaction; these problems were selected on the basis of diagnostic 21 and clinical 2223 criteria for sexual dysfunction.
The purpose of the study was to obtain estimates of the prevalence of sexual activity, behaviors, and problems in the older population. We hypothesized that the profiles of activity and problems would differ between men and women and that differences across age groups would not be uniform for all outcomes.
A second objective was to describe the relationship between sexuality and a variety of health conditions. Indicator variables for arthritis, diabetes, and hypertension were then added to these models.
We used weights to adjust for differential probabilities of selection and differential nonresponse for all analyses. We computed standard errors with the use of the linearization method, 26 taking into the stratification and clustering of the sample de. Reported confidence intervals do not include any adjustment for multiple testing. All analyses were performed by means of Stata statistical software, version 9.
Table 1 summarizes the demographic and health characteristics of the survey respondents.
These characteristics closely match those of respondents in the Current Population Survey 28 and recent national studies of health e. The likelihood of being sexually active declined steadily with age and was uniformly lower among women than among men Table 2.
Panel A shows the percentage of survey respondents who were sexually active in the year. Panel B shows the percentage of survey respondents who were in a spousal or other intimate relationship. Panel C shows the percentage of respondents who were sexually active in the year among those with a spousal or other intimate relationship. Blue symbols denote men, red symbols women, plus s respondents who reported being in excellent or very good health, triangles respondents who reported being in good health, and circles respondents who reported being in fair or poor health.
At any given age, women were less likely than men to be in a marital or other intimate relationship, and this difference increased dramatically with age Fig. Of the men and women in a relationship, only 3 men and 5 women reported that the relationship was with someone of the same sex. Among men and women of the same age, men with a spousal or other intimate relationship were more likely to be sexually active than women with such a relationship. However, the difference in the rates of sexual activity between men and women was considerably smaller among those with a spousal or intimate relationship; this difference reflects, in part, the disparity in ages between men and women within current relationships.
Among respondents Sexual mature in Waverly Illinois were sexually active, the frequency of sex was lower among those who were 75 to 85 years of age than among younger persons Table 2.
The prevalence of masturbation, like that of sexual activity with a partner, was lower among respondents at older ages and was higher among men than among women. Poorer health was also associated with a lower likelihood of masturbation among women Table 2. Approximately half of all respondents both men and women reported having at least one bothersome sexual problem, and almost one third of men and women reported having at least two bothersome sexual problems. As compared with respondents who rated their health Sexual mature in Waverly Illinois being excellent, very good, or good, respondents who rated their health as being fair or poor had a higher prevalence of several problems, including difficulty with erection or lubrication, pain, and lack of pleasure.
Women with diabetes were less likely to be sexually active than women without diabetes Table 3. Diabetes was also associated with a higher likelihood of difficulty with erection among men and a lower likelihood of masturbation among both men and women.
Our findings, based on nationally representative data from the NSHAP, indicate that the majority of older adults are engaged in spousal or other intimate relationships and regard sexuality as an important part of life.
The prevalence of sexual activity declines with age, yet a substantial of men and women engage in vaginal intercourse, oral sex, and masturbation even in the eighth and ninth decades of life. Specific sexual problems were not assessed among sexually inactive adults; therefore, this study probably underestimates their overall prevalence.
Nearly one in seven men reported taking medication to improve sexual function. About one quarter of sexually active older adults with a sexual problem reported avoiding sex as a consequence.
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These persons would be likely to benefit from therapeutic interventions. We found several disparities with regard to the sexuality of men and women at older ages. The impact of age on the availability of a spouse or other intimate partner is particularly marked among women.
This difference may be explained by several factors, including the age structure of marital relationships among older adults men are, on average, married to younger womendifferential remarriage patterns, 31 and the earlier rate of death among men as compared with women.
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Despite a similarly high prevalence of bothersome sexual problems among women and men, we found that women were less likely than men to have discussed sex with a physician. Overall, these low rates of communication are consistent with data from other available reports, including one study of younger women. studies, including the NHSLS, 11 the Global Study of Sexual Attitudes and Behaviors, 3 and a large study of younger adults 16 to 44 years of age in the United Kingdom, 37 showed that sexual dysfunction is associated with poor health.
Our study also showed that sexuality is closely linked to health at older ages, more so for men than for women. Persons in good physical health are more likely to have a spousal or other intimate relationship and are more likely to be sexually active with a partner.
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Consistent with research, our study indicates that diabetes is positively associated with difficulty with erection 738 as well as with a lower prevalence of sexual activity with a partner and masturbation. As has been ly reported, 3711 the prevalence of erectile difficulties is higher at older than at younger ages. Physical health is more strongly associated with many sexual problems than is age alone; this suggests that older adults who have medical problems or who are considering treatment that might affect sexual functioning should be counseled according to their health status rather than their age.
We only assessed the prevalence of specific sexual problems among sexually active persons; therefore, our findings are likely to underestimate the extent of sexual problems in the older population. Moreover, this bias may increase with age, since persons who are experiencing sexual problems are more likely to discontinue sexual activity.
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Prospective, longitudinal data are needed to better understand the associations between sexual problems and future sexual activity or relationships. Laumann reports receiving research funding and support for a research assistant from Pfizer.
Waite reports serving on the eHarmony Research Laboratories Advisory Board and receiving a yearly honorarium. No other potential conflict of interest relevant to this article was reported. National Center for Biotechnology InformationU. N Engl J Med. Author manuscript; available in PMC Jun Stacy Tessler LindauM.
Philip SchummM. LaumannPh. WaitePh. Author information Copyright and information Disclaimer. Address reprint requests to Dr. Maryland Ave. Copyright notice.
The publisher's final edited version of this article is available at N Engl J Med. See other articles in PMC that cite the published article. MEASURES A complete marital and cohabiting history was obtained, with information on the timing of up to three most recent sexual partnerships within the 5 years.
Table 1 Characteristics of Survey Respondents. Open in a separate window.
The confidence interval is based on the inversion of Wald tests constructed with the use of de-based standard errors. Figure 1. Excellent or Very Good Poor or Fair vs. Excellent or Very Good no.