Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men.
Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders.
Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults.
Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey.
Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes.
Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being.
Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
Sexual dysfunctions are characterized by disturbances in sexual desire and in the psychophysiological changes associated with the sexual response cycle in men and women.1 Despite increasing demand for clinical services and the potential impact of these disorders on interpersonal relationships and quality of life,2 - 3 epidemiologic data are relatively scant. Based on the few available community studies, it appears that sexual dysfunctions are highly prevalent in both sexes, ranging from 10% to 52% of men and 25% to 63% of women.4 - 6 Data from the Massachusetts Male Aging Study7 (MMAS) showed that 34.8% of men aged 40 to 70 years had moderate to complete erectile dysfunction, which was strongly related to age, health status, and emotional function. Erectile dysfunction has been described as an important public health problem by a National Institutes of Health Consensus Panel,8 which identified an urgent need for population-based data concerning the prevalence, determinants, and consequences of this disorder. Even less is known about the epidemiology of female sexual dysfunction.
Professional and public interest in sexual dysfunction has recently been sparked by developments in several areas. First, major advances have occurred in our understanding of the neurovascular mechanisms of sexual response in men and women.9 - 11 Several new classes of drugs have been identified that offer significant therapeutic potential for the treatment of male erectile disorder,12 - 14 while other agents have been proposed for sexual desire and orgasm disorders.15 - 16 Availability of these drugs could increase dramatically the number of patients seeking professional help for these problems. Epidemiologic data would be of obvious value in developing appropriate service delivery and resource allocation models. Additionally, changing cultural attitudes and demographic shifts in the population have highlighted the pervasiveness of sexual concerns in all ethnic and age groups.
The present study addresses these issues by analyzing data on sexual dysfunction from the National Health and Social Life Survey (NHSLS), a study of adult sexual behavior in the United States.17 Sampling, data collection, and response analysis were all conducted under highly controlled conditions. This unique data source provides extensive information on key aspects of sexual behavior, including sexual problems and dysfunction, health and lifestyle variables, and sociocultural predictors. Prior analyses of sexual dysfunction, using NHSLS data, are limited, presenting basic prevalence rates across demographic characteristics and indicators of overall health and well-being.17 (pp368-374) The present study, in contrast, uses multivariate techniques to estimate relative risk (RR) of sexual dysfunction for each demographic characteristic as well as for key risk factors.
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