- 作者：Nigel Field ; Catherine H Mercer ; Pam Sonnenberg ; Clare Tanton ; Soazig Clifton ; Kirstin R Mitchell ; Bob Erens ; Wendy Macdowall ; Frederick Wu ; Jessica Datta ; Kyle G Jones ; Amy Stevens ; Philip Prah ; Andrew J Copas ; Andrew Phelps ; Kaye Wellings ; Anne M Johnson
- 刊名：The Lancet
- 出版年：30 November-6 December, 2013
- 年：2013
- 卷：382
- 期：9907
- 页码：1830-1844
- 全文大小：223 K
Summary
Background
Physical and mental health could greatly affect sexual activity and fulfilment, but the nature of associations at a population level is poorly understood. We used data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) to explore associations between health and sexual lifestyles in Britain (England, Scotland, and Wales).Methods
Men and women aged 16-74 years who were resident in households in Britain were interviewed between Sept 6, 2010, and Aug 31, 2012. Participants completed the survey in their own homes through computer-assisted face-to-face interviews and self-interview. We analysed data for self-reported health status, chronic conditions, and sexual lifestyles, weighted to account for unequal selection probabilities and non-response to correct for differences in sex, age group, and region according to 2011 Census figures.
Findings
Interviews were done with 15鈥?62 participants (6293 men, 8869 women). The proportion reporting recent sexual activity (one or more occasion of vaginal, oral, or anal sex with a partner of the opposite sex, or oral or anal sex or genital contact with a partner of the same sex in the past 4 weeks) decreased with age after the age of 45 years in men and after the age of 35 years in women, while the proportion in poorer health categories increased with age. Recent sexual activity was less common in participants reporting bad or very bad health than in those reporting very good health (men: 35路7% [95% CI 28路6-43路5] vs 74路8% [72路7-76路7]; women: 34路0% [28路6-39路9] vs 67路4% [65路4-69路3]), and this association remained after adjusting for age and relationship status (men: adjusted odds ratio [AOR] 0路29 [95% CI 0路19-0路44]; women: 0路43 [0路31-0路61]). Sexual satisfaction generally decreased with age, and was significantly lower in those reporting bad or very bad health than in those reporting very good health (men: 45路4% [38路4-52路7] vs 69路5% [67路3-71路6], AOR 0路51 [0路36-0路72]; women: 48路6% [42路9-54路3] vs 65路6% [63路6-67路4], AOR 0路69 [0路53-0路91]). In both sexes, reduced sexual activity and reduced satisfaction were associated with limiting disability and depressive symptoms, and reduced sexual activity was associated with chronic airways disease and difficulty walking up the stairs because of a health problem. 16路6% (95% CI 15路4-17路7) of men and 17路2% (16路3-18路2) of women reported that their health had affected their sex life in the past year, increasing to about 60% in those reporting bad or very bad health. 23路5% (20路3-26路9) of men and 18路4% (16路0-20路9) of women who reported that their health affected their sex life reported that they had sought clinical help (>80% from general practitioners; <10% from specialist services).
Interpretation
Poor health is independently associated with decreased sexual activity and satisfaction at all ages in Britain. Many people in poor health report an effect on their sex life, but few seek clinical help. Sexual lifestyle advice should be a component of holistic health care for patients with chronic ill health.
Funding
Grants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and Department of Health.