Worldwide survey of attitudes to sex and problems in women and men

Clinical bottom line

Sexual problems for older adults differ in different parts of the world. About four in ten women and three in ten men aged 40-80 years has at least one problem related to sex or intercourse.

References

A Nicolosi et al. Sexual behaviour and sexual dysfunctions after age 40: the global study of sexual attitudes and behaviours. Urology 2004 64: 991-997.

Background

A number of studies in different parts of the world have examined various aspects of male and female sexual attitudes and dysfunction. This very large study took a global perspective.

Study

This was a very large study in sever parts of the world, including:

Northern Europe: Austria, Belgium, Germany, Sweden, UK
Southern Europe: France, Israel, Italy, Spain
Non-European West: Australia, Canada, NZ, South Africa, USA
Central/South America: Brazil, Mexico
Middle East: Algeria, Egypt, Morocco, Turkey
East Asia: China, HK, Japan, Korea, Taiwan
South East Asia: Indonesia, Malaysia, Philippines, Singapore, Thailand

A random selection of adults aged 40 to 80 years was selected, and various methods used for a questionnaire survey, using same-gender interviewers. Questions related to demographics, health, relationships, sexual behaviour, and beliefs.

Respondents were asked specific questions about one or more sexual problems for two months or more during the previous year. Those responding sometimes or frequently were rates as having the problem.

Results

The final total of 27,516 individuals was 19% of the initial eligible individuals. The average age was 53-57 years, and 70-90% of adults were married or in an ongoing relationship. About 70% reported excellent health, though the figure was only about 50% for Middle-eastern and South-Asian women, and women generally reported somewhat worse health than men. Between 20% and 35% reported hypertension and 8-17% diabetes.

Consistently more men (75-90%) than women (50-70%) reported intercourse in the last 12 months. Intercourse frequency of more than once a week was highly variable (Figure 1).

Figure 1: Men and women reporting intercourse frequency of more than once a week

Female sexual dysfunction

Four in 10 women aged 40-80 years had at least one problem (Table 1), with lack of interest in sex the most frequent. There were quite large differences between regions, with lowest rates in Northern Europe (Figure 2).

Table 1: Prevalence of sexual dysfunctions in women, total cohort

Problem	Percent with problem
Lack of interest in sex	21
Inability to achieve organsm	16
Lubrication difficulties	16
Sex not pleasurable	15
Pain during sexual intercourse	10
At least one problem	39
Denominator is the number of women with at least one sexual encounter in the previous 12 months

Figure 2: Women and men with at least one problem, by world region

Male sexual dysfunction

Three in 10 women aged 40-80 years had at least one problem (Table 2), with early ejaculation the most frequent. There were quite large differences between regions, with lowest rates in Northern Europe (Figure 2).

Table 2: Prevalence of sexual dysfunctions in men, total cohort

Problem	Percent with problem
Early ejacualtion	14
Erection difficulty	10
Lack of interest in sex	9
Inability to achieve organsm	7
Sex not pleasurable	6
At least one problem	28
Denominator is the number of men with at least one sexual encounter in the previous 12 months

Comment

Additional analysis by age and frequency of problems showed, as expected, that frequent problems are found more frequently at older age. For women there was a shallow relationship between problems and age, while for men there was a strong relationship with age for erectile difficulties, lack of sexual interest, and inability to reach orgasm.

Other publications from the survey did not show any more consistent relationships between sexual problems and demographic factors.