- 作者：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
- 刊名：The Lancet
- 出版年：30 November-6 December, 2013
- 年：2013
- 卷：382
- 期：9907
- 页码：1817-1829
- 全文大小：565 K
Summary
Background
Despite 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.Methods
We undertook a probability sample survey (the third National Survey of Sexual Attitudes and Lifestyles [Natsal-3]) of 15鈥?62 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鈥?90 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.
Findings
We 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路70 [95% CI 2路90-4路72] for men and 4路11 [3路36-5路04] for women) and self-reported poor health status (2路63 [1路73-3路98] and 2路41 [1路72-3路39]). Low sexual function was also associated with experiencing the end of a relationship (1路52 [1路18-1路95] and 1路77 [1路44-2路17]), inability to talk easily about sex with a partner (2路36 [1路94-2路88] and 2路82 [2路28-3路48]), and not being happy in the relationship (2路89 [2路32-3路61] and 4路10 [3路39-4路97]). Associations were also noted with engaging in fewer than four sex acts in the past 4 weeks (3路13 [2路58-3路79] and 3路38 [2路80-4路09]), having had same sex partners (2路28 [1路56-3路35] and 1路60 [1路16-2路20]), paying for sex (in men only; 2路62 [1路46-4路71]), and higher numbers of lifetime sexual partners (in women only; 2路12 [1路68-2路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路98 [1路14-3路43] and 2路18 [1路79-2路66]) and STI diagnosis (1路50 [1路06-2路11] and 1路83 [1路35-2路47]). Among individuals reporting sex in the past year, problems with sexual response were common (41路6% of men and 51路2% of women reported one or more problem) but self-reported distress about sex lives was much less common (9路9% and 10路9%). For individuals in a sexual relationship for the past year, 23路4% of men and 27路4% of women reported an imbalance in level of interest in sex between partners, and 18路0% of men and 17路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 avoiding sex because of sexual difficulties.
Interpretation
Wide variability exists in the distribution of sexual function scores. Low sexual function is associated with negative sexual health outcomes, supporting calls for a greater emphasis on sexual function in sexual health policy and interventions.
Funding
Grants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health.