Sexual function in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Abstract

SummaryBackgroundDespite its importance to sexual health and wellbeing, sexual function is given little attention in sexual health policy. Population-based studies are needed to understand sexual function across the life course.MethodsWe undertook a probability sample survey (the third National Survey of Sexual Attitudes and Lifestyles [Natsal-3]) of 15 162 individuals aged 16–74 years who lived in Britain (England, Scotland, and Wales). Interviews were done between Sept 6, 2010, and Aug 31, 2012. We assessed the distribution of sexual function by use of a novel validated measure (the Natsal-SF), which assessed problems with individual sexual response, sexual function in a relationship context, and self-appraisal of sex life (17 items; 16 items per gender). We assess factors associated with low sexual function (defined as the lowest quintile of distribution of Natsal-SF scores) and the distribution of components of the measure. Participants reporting one or more sexual partner in the past year were given a score on the Natsal-SF (11 690 participants). 4122 of these participants were not in a relationship for all of the past year and we employed the full information maximum likelihood method to handle missing data on four relationship items.FindingsWe obtained data for 4913 men and 6777 women for the Natsal-SF. For men and women, low sexual function was associated with increased age, and, after age-adjustment, with depression (adjusted odds ratio 3·70 [95% CI 2·90–4·72] for men and 4·11 [3·36–5·04] for women) and self-reported poor health status (2·63 [1·73–3·98] and 2·41 [1·72–3·39]). Low sexual function was also associated with experiencing the end of a relationship (1·52 [1·18–1·95] and 1·77 [1·44–2·17]), inability to talk easily about sex with a partner (2·36 [1·94–2·88] and 2·82 [2·28–3·48]), and not being happy in the relationship (2·89 [2·32–3·61] and 4·10 [3·39–4·97]). Associations were also noted with engaging in fewer than four sex acts in the past 4 weeks (3·13 [2·58–3·79] and 3·38 [2·80–4·09]), having had same sex partners (2·28 [1·56–3·35] and 1·60 [1·16–2·20]), paying for sex (in men only; 2·62 [1·46–4·71]), and higher numbers of lifetime sexual partners (in women only; 2·12 [1·68–2·67] for ten or more partners). Low sexual function was also associated with negative sexual health outcomes such as experience of non-volitional sex (1·98 [1·14–3·43] and 2·18 [1·79–2·66]) and STI diagnosis (1·50 [1·06–2·11] and 1·83 [1·35–2·47]). Among individuals reporting sex in the past year, problems with sexual response were common (41·6% of men and 51·2% of women reported one or more problem) but self-reported distress about sex lives was much less common (9·9% and 10·9%). For individuals in a sexual relationship for the past year, 23·4% of men and 27·4% of women reported an imbalance in level of interest in sex between partners, and 18·0% of men and 17·1% of women said that their partner had had sexual difficulties. Most participants who did not have sex in the past year were not dissatisfied, distressed, or avoid...

Sexuality in Older Adults (65+)—An Overview of the Literature, Part 1: Sexual Function and its Difficulties

“…Accordingly, in the Natsal-3 survey, among sexually active women aged 65-74 years, 55.7% reported one or more sexual problem lasting three months or longer in the past year. The most common sexual problem reported in the Natsal-3 survey among this cohort was lack of interest in having sex followed by "uncomfortably dry vagina" (20.0%), and difficulty reaching climax (13.7%) (Mitchell et al, 2013).…”

“…One reason for this has to do with the fact that a number of early population-based surveys on sexuality did not include older women (e.g., Laumann, Paik, & Rosen, 1999;Najman, Dunne, Boyle, Cook, et al, 2003;Öberg, Fugl-Meyer, & Fugl-Meyer, 2004). However, more recent surveys such as the third U.K. National Survey of Sexual Attitudes and Lifestyles (Natsal-3) (Mitchell, Mercer, Ploubidis, Jones, et al, 2013) and the U.S. National Social Life, Health, and Aging Project (Laumann, Das, & Waite, 2008) did include women over 65 years. Accordingly, in the Natsal-3 survey, among sexually active women aged 65-74 years, 55.7% reported one or more sexual problem lasting three months or longer in the past year.…”

“…For example, older adults reporting 'fair' or 'bad' health, or who have been diagnosed with a medical condition, are less likely to report being sexually active, more likely to report sexual problems (DeLamater, 2012;Field, Mercer, Sonnenberg, Tanton, et al, 2013;Moreira, Glasser, King, Duarte, et al, 2008), and experience less frequent or more dissatisfying sexual relations (DeLamater & Karraker, 2009). Further, side effects of medication often include adverse sexual side effects such as reduced sexual desire, erectile dysfunction, and delayed orgasm (Field et al, 2013;Graugaard et al, 2012). These side effects are also prevalent among older adults and have been shown to reduce treatment compliance, treatment satisfaction, and quality of life (Krag, Nielsen, Norup, et al, 2004;Lundberg, 2006;Numberg & Hensley, 2003).…”

Painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey

“…Although painful sex is less commonly reported by women than lacking interest in sex and difficulty reaching climax,39 it is the sexual function problem most commonly experienced as distressing 28. It can lead to feelings of isolation, shame, sexual inadequacy, loss of confidence and feeling out of control 7, 8, 38.…”

The Natsal-SF Measure of Sexual Function: Comparison of Three Scoring Methods

“…Details of the methodology and question wording are published elsewhere (Erens et al, 2014;Mercer et al, 2013). Briefly, and of relevance to this article, Natsal-3 was administered as a computerassisted personal interview in participants' homes, and used computer-assisted self-interview for the more sensitive questions, including those used to derive the Natsal-SF.…”