Sex in Australia: Autoerotic, esoteric and other sexual practices engaged in by a representative sample of adults

Sexuality and the menopause

Sexuality is innate within all women to a greater or lesser extent, and is affected by a number of extrinsic factors that occur in the menopausal transition. Assessing hormone status is difficult as evidence exists that sex hormones may differ between ethnic groups, and that bio-assays may be insensitive at lower testosterone levels. Data are available on the prevalence of female sexual dysfunction, but results from cross-sectional studies differ from those of longitudinal studies. The original traditional models of human sexual response have been challenged, and new models have been defined which show more complex interaction between intrinsic and extrinsic factors. Definitions of sexual dysfunction have been redefined. There are a limited number of randomized, placebo-controlled trials of drugs to improve sexual function. These include sildenafil citrate, tibolone and hormone replacement therapy. Randomized controlled trials on testosterone replacement in naturally and/or surgically menopausal patients with female sexual dysfunction have been criticized for a high placebo response rate and short duration. This chapter seeks to put sexuality into perspective and to define both function and dysfunction.

Correlates of sexual satisfaction among sexually active postmenopausal women in the Women's Health Initiative-Observational Study

BACKGROUND

Satisfaction with sexual activity is important for health-related quality of life, but little is known about the sexual health of postmenopausal women.

OBJECTIVE

Describe factors associated with sexual satisfaction among sexually active postmenopausal women.

DESIGN

Cross-sectional analysis.

PARTICIPANTS

All members of the Women's Health Initiative-Observational Study (WHI-OS), ages 50-79, excluding women who did not respond to the sexual satisfaction question or reported no partnered sexual activity in the past year (N = 46,525).

MEASUREMENTS

PRIMARY OUTCOME

dichotomous response to the question, "How satisfied are you with your sexual activity (satisfied versus unsatisfied)?" Covariates included sociodemographic factors, measures of physical and mental health, and gynecological variables, medications, and health behaviors related to female sexual health.

RESULTS

Of the cohort, 52% reported sexual activity with a partner in the past year, and 96% of these answered the sexual satisfaction question. Nonmodifiable factors associated with sexual dissatisfaction included age, identification with certain racial or ethnic groups, marital status, parity, and smoking history. Potentially modifiable factors included lower mental health status and use of SSRIs. The final model yielded a c-statistic of 0.613, reflecting only a modest ability to discriminate between the sexually satisfied and dissatisfied.

CONCLUSIONS

Among postmenopausal women, the variables selected for examination yielded modest ability to discriminate between sexually satisfied and dissatisfied participants. Further study is necessary to better describe the cofactors associated with sexual satisfaction in postmenopausal women.

Attitudes of men in an Australian male tolerance study towards microbicide use

BACKGROUND

Vaginal microbicides are in development to provide new options for the prevention of sexually transmissible infections. Although promoted as a female-initiated product, men may influence the decision to use a microbicide and the way that it is used, so it is important to explore their views.

METHODS

Men (n = 36) enrolled in a 7-day, phase 1 clinical safety trial of SPL7013 Gel were interviewed pre- and post-use of the gel. The trial did not include use of the gel during sex. Interviews were digitally-recorded and transcribed verbatim, and analysed using a framework approach.

RESULTS

The men (mean age 37 years) were interested in the idea of vaginal microbicides, had little knowledge about them, and varied beliefs about how they work. They tended to assess microbicide use in relation to condoms and lubricants. Many would want a microbicide to be as effective as condoms. Participants did not anticipate difficulties discussing use with their partners. Many thought that a microbicide would be less intrusive than condoms; some anticipated that the lubricating properties might enhance sexual pleasure. Some anticipated using a microbicide with a condom or with a lubricant, and a few raised questions about the timing of use and use during different types of sexual activity.

CONCLUSIONS

No major barriers to microbicide use were found in this sample of Australian men, who anticipated being willing to use them if they are shown to be safe and effective. Our findings should help to inform the design of further studies as well as future information materials and anticipatory guidance.

Neurodevelopmental correlates of paraphilic sexual interests in men

The etiology of anomalous, or paraphilic, sexual preferences in men is unclear although a growing literature points to their prenatal neurodevelopmental ontogenesis. The present study explored whether this was also apparent in a community sample of 200 heterosexual men by examining their sexual fantasies using the Wilson Sex Fantasy Questionnaire (WSFQ) and several demographic and somatic neurodevelopmental markers, including sibling sex composition, handedness, maternal and paternal age at birth, second to fourth finger length ratios, and fluctuating asymmetry of finger lengths and wrist widths. Responses to the WSFQ were used to quantify the extent of paraphilic interest by computing a variance-quotient (or VQ) previously shown to differentiate paraphilic from conventional heterosexual males. High paraphilic scorers had a significantly greater number of older brothers, higher right-hand 2D:4D, and a trend for lower Edinburgh Handedness Inventory (EHI) scores compared to low-paraphilic scorers. Correlational analysis revealed a significant positive association of VQ scores with number of older brothers and significant negative associations with number of younger brothers and EHI scores (elevated paraphilic interests were correlated with elevated non-right handedness). Correlations between VQ scores and other variables were not significant. It is suggested that processes such as developmental instability and maternal immunity may play a role in variant sexual preferences among otherwise healthy heterosexual men.

Psychotherapists' experience with clients who engage in consensual sadomasochism: a qualitative study

Consensual sadomasochism (Bondage and Discipline, Dominance and Submission, Sadism and Masochism; BDSM) is relatively common, but the experience of psychotherapists who work with clients who engage in BDSM has received little study. We conducted semistructured interviews with 14 therapists experienced in working with BDSM clients. Interviews were recorded, transcribed, and analyzed for thematic content. Therapists emphasized the importance of cultural competence, including a nonjudgmental attitude and knowledge of BDSM practices and cultural values. BDSM was rarely a central issue in therapy, relationship issues were clients' most common presenting concerns. Therapists who practiced BDSM themselves often encountered boundary issues with clients.

Sex in Australia: Heterosexual experience and recent heterosexual encounters among a representative sample of adults

OBJECTIVE

To describe numbers of opposite-sex partners, experiences of different heterosexual behaviours, and recent heterosexual experiences among a representative sample of Australian adults.

METHODS

Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The response rate was 73.1% (69.4% among men and 77.6% among women).

RESULTS

Men reported more sexual partners than women over their lifetime, in the past five years and in the past year. 15.1% of men and 8.5% of women reported multiple sexual partners in the past year. Reporting multiple opposite-sex partners was significantly associated with being younger, identifying as bisexual, living in major cities, having a lower income, having a blue-collar occupation, and not being married. All but a handful of respondents' most recent heterosexual encounters involved vaginal intercourse and condoms were used in one-fifth of these sexual encounters. Anal intercourse was very uncommon during respondents' most recent heterosexual encounters.

CONCLUSION

Patterns of heterosexual experience in Australia are similar to those found in studies of representative samples in other countries.

IMPLICATIONS

There may be a need for interventions targeted at people with multiple sexual partners to promote safer sexual behaviour and to reduce the likelihood of transmission of HIV and other sexually transmitted infections.

Sex in Australia: Reflections and recommendations for future research

OBJECTIVE

To review the content, method and process of the Australian Study of Health and Relationships (ASHR).

RESULTS

ASHR achieved a large sample, a high response rate and documented the sexual life histories and current sexual health-related knowledge, attitudes and practices of the Australian population aged 16-59. Its cross-sectional nature limited our ability to partition observed variation between age and time despite clear evidence of both age-related and cohort-related changes in sexual practice. Similarly, its reliance on a sample of individuals reporting on their sexual experiences rather than a sample of sexual relationships or encounters and their participants limits our ability to understand the dynamics of those relationships and encounters. Finally, our understanding of sexuality in Australia could have been improved through qualitative studies with a subsample of ASHR participants.

CONCLUSION

ASHR represents a significant contribution to our understanding of sexual health-related knowledge, attitudes and practices in Australia.

A typology of men's sexual attitudes, erectile dysfunction treatment expectations and barriers

In total, 1122 men completed non-validated structured interviews on sexual attitudes and on erectile dysfunction treatment expectations and barriers. Dimensions of sexual attitudes and treatment expectations and barriers were extracted by factor analysis and subjects were grouped into types by cluster analysis. Five types emerged: the sensation seeker, the sensuous, the anxious, the confident and the abstinent. The majority of men agreed on the importance of sex for the partnership. For the majority of anxious, sensuous and sensation-seeking men, sex was important for self-esteem. Expecting quality of life, enjoyment, self-esteem and hard reliable erections from treatment with phosphodiesterase-5 inhibitors, anxieties for side effects and loss of control, sexual abstinence and desire for an intensive sex life had the strongest impact on the likelihood of use. Men's sexual attitudes vary considerably and impact reactions to erection difficulties. A typology of five groups was developed, which will contribute to research on and understanding of men's sexual and treatment-seeking behaviors.

Sexual practices at last heterosexual encounter and occurrence of orgasm in a national survey

In order to examine factors associated with orgasm in heterosexual encounters, we analyzed data from the Australian Study of Health and Relationships, a national telephone survey of sexual behavior and attitudes and sexual health knowledge carried out in 2001-2002 with a representative sample of 19,307 Australians aged 16 to 59. Respondents were asked whether at their last sexual encounter they gave or received manual stimulation and oral sex, had vaginal intercourse or anal intercourse, and whether they had an orgasm. Vaginal intercourse was the dominant practice: 95% of encounters included it. Of the 64 possible combinations of these practices, 13 account for 93% of encounters: vaginal intercourse alone (12%), vaginal + manual stimulation of the man's and/or woman's genitals (49%), and vaginal intercourse + manual + oral (32%). Encounters may also have included other practices. Men had an orgasm in 95% of encounters and women in 69%. Generally, the more practices engaged in, the higher a woman's chance of having an orgasm. Women were more likely to reach orgasm in encounters including cunnilingus. This is the first large-scale empirical study worldwide to link specific practices with orgasm. Demographic and sexual history variables were comparatively weakly associated with orgasm.

The Impact of Aging on Sexual Function and Sexual Dysfunction in Women: A Review of Population‐Based Studies

INTRODUCTION

Scientific interest in the impact of aging on women's sexual function and dysfunction has increased in the half century since Kinsey described age-related changes in women's sexual activities. However, a range of methodological issues limit the conclusions that can be drawn from many published studies in this area.

AIM

To review community-based studies investigating changes in women's sexual function and sexual dysfunction with age, taking into account confounders to aging and methodological limitations.

METHODS

Electronic databases were searched for published studies investigating changes in sexual function and dysfunction with age. A critical review was carried out.

MAIN OUTCOME MEASURES

Age-related changes in sexual function and dysfunction.

RESULTS

There are inconsistencies in the way sexual function and sexual dysfunction are measured. Validated scales are infrequently used. Low response rates, limited age ranges, and restrictive inclusion criteria limit the generalizability of many studies. Confounders are often either not measured or not analyzed. Longitudinal studies are rare, making it difficult to separate the effects of birth cohort and aging. The evidence indicates that a woman's sexual function declines with age. This decline begins in a woman's late 20s to late 30s. Specifically, desire, frequency of orgasm, and frequency of sexual intercourse decrease with age. However, it is not clear whether arousal decreases or remains relatively constant. In longitudinal studies, decline in women's sexual function has also been detected, but patterns of stability and improved sexual function have also been observed for short periods of time. The prevalence of most sexual difficulties or dysfunctions changes little with age, with the exception of sexual pain, which may decrease.

CONCLUSIONS

Age-related changes in sexually related personal distress may help explain why the prevalence of sexual dysfunctions remains constant with age while sexual function declines. More research is needed to demonstrate this.