London School of Hygiene & Tropical Medicine

Around half (51%) of women and four out of ten (42%) men report having had a recent sexual problem, but only one in ten say they are worried or distressed about their sex life, according to new results from the third National Survey of Sexual Attitudes and Lifestyles (Natsal), published in The Lancet.

The research uses a new scientific measure to increase understanding of sexual function – the extent to which an individual is able to participate in and enjoy a sexual relationship – which takes account not only of sexual problems, but also of the relationship in which they occur, and the degree of personal distress and dissatisfaction caused by them.

Survey participants who had ever been in a sexual relationship were asked a standard set of questions comprising the new measure* to evaluate their overall sexual function. The researchers, led by Dr Kirstin Mitchell at the London School of Hygiene & Tropical Medicine in partnership with UCL and NatCen Social Research, then looked at the relationship between low sexual function scores, and aspects of health and sexual lifestyles. Over 15,000 adults aged 16-74 years participated in interviews between September 2010 and August 2012.

Men and women in the oldest age groups surveyed (55–74) were more likely to have low overall sexual function than those in the youngest age group (16–24). After taking account of age differences, low sexual function was associated in both men and women with being unemployed, with current depression, and with poor general health. It was also associated with higher numbers of lifetime partners (women only), paying for sex (men only), and reporting same-sex partners, as well as with other aspects of sexual health, such as being diagnosed with an STI and experiencing sex against their will.

Low sexual function was associated with relationship breakdown, and with people not being happy with their relationship. Within relationships, the most common problem was an imbalance in level of interest in sex between partners, which affected around a quarter of both men and women. Just under one in five men and women said their partner had experienced sexual difficulties in the last year, and this proportion increased with age, particularly among women.

Lack of interest in sex was one of the most commonly reported problems for both men and women, affecting three in every twenty (15%) men, and with women twice as likely as men to say that this had been an issue in the last year. Difficulty reaching climax (16%) and vaginal dryness (13%) were among common problems for women; and reaching a climax more quickly than desired (15%), and difficulty getting or keeping an erection (13%) among men. Sexual dissatisfaction and avoidance of sex were higher among those who did not have sex in the past year than among those who did, but the majority of sexually inactive individuals reported that they were not dissatisfied, distressed, or avoiding sex because of sexual difficulties.

Study lead author Dr Mitchell, of the London School of Hygiene & Tropical Medicine, said: “Our data highlight the fact that we need to take account of the personal significance of sexual problems for men and women, and their partners. We hope that this study will encourage a move away from ways of measuring sexual function that over-medicalise sexual problems, towards one that takes into account the relationship in which they occur, and the level of personal dissatisfaction and distress they cause.”

The study was funded by the Medical Research Council and The Wellcome Trust, with additional funding from the Economic & Social Research Council and the Department of Health.

* The Natsal-SF score has three components:

1. Problems with sexual response (lacked interest in sex, lacked enjoyment in sex, felt anxious during sex, felt physical pain as a result of sex, felt no excitement or arousal during sex, difficulty reaching a climax, reached climax more quickly than desired, uncomfortably dry vagina [women] and difficulty getting or keeping an erection [men]);
2. Sexual function in relationship context (whether partner shares the same level of interest in sex, whether partner shares the same likes and dislikes, whether the partner has experienced difficulties in the past year, and whether respondent feels emotionally close to their partner during sex) and;
3. Appraisal of sex life (dissatisfaction with sex life, distress or worry about sex life, whether sex has been avoided because of sexual difficulties, seeking help regarding one’s sex life).

• Kirstin R Mitchell, Catherine H Mercer, George B Ploubidis, Kyle G Jones, Jessica Datta, Nigel Field, Andrew J Copas, Clare Tanton, Bob Erens, Pam Sonnenberg, Soazig Clifton, Wendy Macdowall, Andrew Phelps, Anne M Johnson, Kaye Wellings. Sexual function in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). The Lancet. DOI: 10.1016/S0140-6736(13)62366-1