Sexual touching and difficulties with sexual arousal and orgasm among U.S. older adults

Sexual Expression and Subsequent Marital Quality Among Partnered Older Adults

A great deal of research has linked aspects of couples' sex lives to the quality of their relationships. Yet most of this work is with younger couples. Although sexual frequency is associated with positive marital quality, less is known regarding how sexual expression-sexual attitudes, desires, and behaviors-influences later positive and negative marital quality, particularly in older couples. Using latent class analysis and dyadic data on 620 heterosexual couples in long-term marriages from Rounds 2 and 3 of the National Social Life, Health, and Aging Project, we examined how couple-level configurations of sexual expression influence later marital quality. Generally, the latent classes with more agreement on sexual expression and higher overall sexual frequency were associated with later higher positive marital quality for both wives and husbands. Sexual expression configurations were associated with wives' negative marital quality, not husbands' negative marital quality. Across classes, wives' better mental health and husbands' functional limitations were associated with later marital quality. It is essential for practitioners to recognize the relevance of sexual expression to marital quality in older couples.

The lifelong orgasm gap: exploring age's impact on orgasm rates

Background

Research demonstrates significant gender- and sexual orientation-based differences in orgasm rates from sexual intercourse; however, this "orgasm gap" has not been studied with respect to age.

Aim

The study sought to examine age-related disparities in orgasm rates from sexual intercourse by gender and sexual orientation.

Methods

A survey sample of 24 752 adults from the United States, ranging in age from 18 to 100 years. Data were collected across 8 cross-sectional surveys between 2015 and 2023.

Outcomes

Participants reported their average rate of orgasm during sexual intercourse, from 0% to 100%.

Results

Orgasm rate was associated with age but with minimal effect size. In all age groups, men reported higher rates of orgasm than did women. Men's orgasm rates ranged from 70% to 85%, while women's ranged from 46% to 58%. Men reported orgasm rates between 22% and 30% higher than women's rates. Sexual orientation impacted orgasm rates by gender but not uniformly across age groups.

Clinical Translation

The persistence of the orgasm gap across ages necessitates a tailored approach in clinical practice and education, focusing on inclusive sexual health discussions, addressing the unique challenges of sexual minorities and aging, and emphasizing mutual satisfaction to promote sexual well-being for all.

Strengths and Limitations

This study is the first to examine the orgasm gap with respect to age, and does so in a large, diverse sample. Findings are limited by methodology, including single-item assessments of orgasm and a sample of single adults.

Conclusion

This study revealed enduring disparities in orgasm rates from sexual intercourse, likely resulting from many factors, including sociocultural norms and inadequate sex education.

Not Who You Are, But Who You Are With: Re-examining Women's Less Satisfying Sexual Debuts

Gender differences in appraisals of first intercourse are among the largest in sexuality research, with women indicating less satisfying "sexual debuts" than men. Dispositional or "actor-level" explanations for this gender gap are pervasive, yet research has largely examined heterosexual debuts in which actor gender and partner gender are confounded. We assessed whether women's less satisfying sexual debuts are better explained by actor gender or partner gender, comparing experiences of women who debuted with men (WDM) with those of men and women who debuted with women (MDW, WDW). Retrospective accounts of sexual debut were collected from 3033 adults. At first intercourse, we found that WDW had equal physical and emotional satisfaction to MDW, and more satisfaction than WDM, suggesting satisfaction gaps owing to partner gender, not actor gender. This pattern did not extend to a comparison event (first masturbation), where WDW and WDM had similar satisfaction, but less satisfaction than MDW, suggesting an actor gender gap. To identify sources of satisfaction gaps, we probed for corresponding differences in the circumstances of sexual debut. Sexual circumstances were more strongly implicated than nonsexual ones, with relative deprivation of glans stimulation explaining relative dissatisfaction at first intercourse, but not first masturbation, and orgasm explaining it at both. Findings challenge the view that the satisfaction gap at first intercourse reflects an inherent difference between genders. Indeed, they demonstrate similarities when partner gender does not differ and suggest strategies for ensuring equal sexual satisfaction-and equal sexual rights realization-at (hetero) sexual debut.

Effect of sexual enrichment program on the sexual satisfaction of pregnant women in Iran: A randomized clinical trial

Background

To improve the sexual satisfaction of pregnant women, there needs to be a culturally appropriate sex education program. This study aimed at determining the effectiveness of a sexual enrichment program on the sexual satisfaction of pregnant women.

Methods

This single-blind randomized clinical trial was conducted on 61 pregnant women aged 18 to 35 years old with low-risk pregnancies and gestational ages of 14 to 32 weeks, who had referred to three healthcare centers in Mashhad. The participants were randomly assigned to two groups of control (n = 31) and intervention (n = 30) based on a table of blocks of four. The intervention group, in addition to receiving routine pregnancy training, participated in six one-hour sessions of a sexual enrichment program held on a weekly basis, while the control group received only the routine pregnancy healthcare. Larson's sexual satisfaction questionnaire was used to assess the sexual satisfaction of pregnant women prior to the study and two weeks after the intervention. Comparison of mean scores between and within the two groups was performed using SPSS software (version 21) using independent and paired t-tests.

Results

After the intervention, there was a significant difference between the mean sexual satisfaction scores of the two groups (p = 0.02). Comparison of the differences between the mean sexual satisfaction scores of the intervention group before and after the intervention indicated a significant change (p = 0.009), while in case of the control group this change was not significant (p = 0.46).

Conclusion

A sexual enrichment program can be effective in improving the sexual satisfaction of pregnant mothers.

Genetic characterization of HIV-1 epidemic in Anhui Province, China

Background

Anhui Province in China is facing a severe HIV epidemic with an increasing number of newly diagnosed cases.

Methods

In this study, HIV genetic characteristics in the province were investigated. Newly reported HIV-positive individuals from 15 districts of Anhui Province were enrolled and interviewed. Total viral RNA was extracted from plasma isolated from blood samples. We amplified and sequenced an HIV pol fragment of the 1062 bp. The sequences were used for determination of HIV subtypes and the presence of drug resistance mutations. Transmission networks were constructed to explore possible relationships. And all of assembled partial pol genes were submitted to the Stanford HIV Drug Resistance Database website to find the transmitted drug resistance.

Results

Partial pol gene sequences were obtained from 486 cases. The results showed that MSM was the most dominant transmission route (253, 52.06%), followed by heterosexual transmission (210, 43.21%) and blood-borne transmission (1, 0.21%). Many subtypes were identified, including CRF01_AE (226, 46.50%), CRF07_BC (151, 31.07%), subtype B (28, 5.76%), CRF08_BC (20, 4.12%), CRF55_01B (15, 3.09%), CRF68_01B (7, 1.44%), CRF67_01B (3, 0.62%), CRF57_BC (2, 0.41%), CRF59_01B (2, 0.41%), CRF79_0107 (2, 0.41%), subtype C (2, 0.41%), CRF64_BC (1, 0.21%), and circulating recombinant forms (URFs) (27, 5.55%). Four transmission subnetworks containing high transmission risk individuals (with degree ≥4) were identified based on CRF01_AE and CRF07_BC sequences, including two CRF01_AE transmission subnetworks constituted by elderly people with average ages of 67.9 and 61.5 years. Infection occurred most likely through heterosexual transmission, while the other two CRF07_BC transmission subnetworks consist mainly of MSMs with average ages of 31.73 and 34.15. The level of HIV-transmitted drug resistance is 3.09%.

Conclusions

The simultaneous spread of multiple HIV subtypes in Anhui province underscores that close surveillance of the local HIV epidemic is necessary. Furthermore, the elderly people were frequently involved, arguing for behaviour intervention in this specific population besides the MSM risk group.

Phylogenetic analysis highlights the role of older people in the transmission of HIV-1 in Fuyang, Anhui Province, China

Background

The proportion of older HIV-1 infected people in China has increased rapidly in recent years. Elucidation of the transmission characteristics of this high-risk population subgroup is helpful for the development of tailored interventions.

Methods

A phylogenetic analysis was performed that uses available HIV-1 pol sequences amplified with nested RT-PCR from plasma samples of all newly diagnosed participants spanning from October 2017 to September 2018 in Fuyang, Anhui Province. Transmission clusters were identified as two or more sequences that shared a corresponding node with an aLRT-SH value ≥90 in the maximum-likelihood phylogenetic tree and had an overall mean genetic distance of ≤1.5%. A local transmission cluster was defined as a cluster that had more than 80% of its sequences from Fuyang. The role of older people in local HIV-1 transmission was determined using an integration of molecular and demographic data.

Results

Of 362 available sequences, 14 subtypes, and 28 local transmission clusters were identified. It was found that the proportion of older people in the local transmission cluster (69/77, 89.61%) was much higher than that of younger people (46/114, 40.35%) (χ² test, P < 0.001). In the pretreatment drug resistance analysis, the proportion of sequences with PDRMs in the local transmission cluster was not significantly different between the older people group (57.14%, 4/7) and non-old-aged group (11.11%, 1/9) (Fisher’s exact test, P > 0.05).

Conclusion

By combining phylogenetic analyses with demographic data, more detailed information was provided about the local transmission structure in Fuyang. These findings suggested that older people play an important role in local transmission, and more tailored interventions for this population subgroup are urgently needed.

A National Dyadic Study of Oral Sex, Relationship Quality, and Well-Being among Older Couples

Objectives

We examine how giving versus receiving oral sex, 2 processes that are linked to relationship quality, are associated with older men's and women's well-being.

Method

We analyzed 884 heterosexual couples from the National Social Life, Health, and Aging Project (2010-2011). We estimate Actor-Partner Interdependence Models using the SEM approach to assess three well-being outcomes: general happiness, psychological distress, and self-reported mental health.

Results

Older adults with better relationship quality gave oral sex to their partner more often than those with worse relationship quality; this association was stronger for men than for women. While receiving oral sex was positively related to both men's, and women's perceptions of relationship quality, women's relationship quality was more strongly linked to their partners' well-being than men's. Correspondingly, men's giving of oral sex (and thus their female partner's receiving of oral sex) was positively related to their own well-being through increasing their female partner's perceived relationship quality.

Discussion

Given the high prevalence of sexual dysfunctions among older adults, oral sex may play an important but overlooked role in maintaining an active sexual life, a high-quality relationship, and psychological vibrancy in late life.

The Mediating Role of Sexual Behavior in Event-Level Associations Between Sexual Difficulties and Sexual Satisfaction in Newlywed Mixed-Sex Couples

INTRODUCTION

Many sexual difficulties encountered by couples in their day-to-day lives, although of insufficient intensity and persistence to warrant a clinical diagnosis of sexual disorder, are nevertheless frequent and a source of individual and relational distress.

AIM

The aim of this study was to assess the event-level associations between couples' everyday, subclinical sexual difficulties (specifically, low subjective sexual arousal, low physiological sexual arousal, and genito-pelvic pain), the range of sexual behaviors that these couples engage in, and their sexual satisfaction.

METHODS

70 Newlywed participants (35 couples, average age = 25.6 years, SD = 3.2 years; average duration of relationship = 5.4 years, SD = 3.4 years) individually completed daily diaries about sexual difficulties, range of activities performed during sex, and sexual satisfaction over the course of 5 weeks. Analyses were guided by the actor-partner interdependence model.

MAIN OUTCOME MEASURE

The main outcome was sexual satisfaction, measured at the event-level on a 5-point Likert scale using a single-item question.

RESULTS

On days of sexual activity, men and women's difficulties with subjective sexual arousal were associated with lower sexual satisfaction in both partners (actor and partner effects). This association was mediated by the range of couples' sexual behaviors, such that lower subjective arousal was associated with a more restricted range of sexual activities, which in turn was associated with lower sexual satisfaction. Men's and women's difficulties with physiological sexual arousal, and women's genito-pelvic pain, were each associated with their own lower sexual satisfaction. No partner effects were observed for these sexual difficulties, nor were they mediated by the range of couples' sexual activities.

CLINICAL IMPLICATIONS

The study's results highlight how couples' sexual difficulties can interfere with same-day sexual satisfaction, and how for subjective sexual arousal, this interference is reflected by a more restricted range of sexual behaviors.

STRENGTH & LIMITATIONS

Strengths of the study include the daily diary methodology, which allowed a focus on event-level sexual activities with minimal retrospective bias. Further, the dyadic analyses allowed both intra-individual and inter-individual effects to be assessed. Limitations include the lack of a more general measure of sexual desire and of a more diverse sample, in terms of age, race, and sexual orientation.

CONCLUSION

These findings underscore the importance of treatments that include both partners, and that target the types as well as range of sexual activities in which couples engage. Jodouin J-F, Bergeron S, Janssen E. The Mediating Role of Sexual Behavior in Event-Level Associations Between Sexual Difficulties and Sexual Satisfaction in Newlywed Mixed-Sex Couples. J Sex Med 2018;15:1384-1392.

An integrated model to understand sexuality in older adults in urban China: The mediating role of sexual interest

BACKGROUND

The subject of sexuality in older adults has remained grossly understudied in China, despite the country having the largest older population in the world.

OBJECTIVE

Guided by the Sexual Script Theory and the Theory of Planned Behavior (TPB), this study used path analysis to test an integrated path model for sexual activity with sexual interest as a mediator.

METHODS

Survey data was collected from a representative sample of 688 community-dwelling older Chinese adults aged 60 or above residing in Tianjin, China.

RESULTS

The final integrated model yielded a satisfactory model fit. Sexual knowledge, sexual attitude and perceived sexual control have direct positive effects on sexual interest in sample older Chinese. Furthermore, sexual interest mediated the effect of sexual knowledge, sexual attitude, perceived sexual control, available sexual partner, male gender and education level on sexual activities. Age was found negatively associated with sexual activities, while a non-significant relationship for sexual interest was observed. Male gender positively associated with sexual activities and sexual interest. In addition, education level has a positive effect on sexual interest.

CONCLUSION

The integrated model highlighted the mediating role of sexual interest on sexual activities, thereby contributes to advancements of understanding of sexuality in older Chinese population.The current study also provides empirical evidence to the development of intervention and education programmes on sexuality among older Chinese adults. These programmes should pay attention to address the issues of sexual interest and partnership in older adults. Frontline health professionals should be sensitive to the needs of sex education in older population.

Female Sexual Dysfunction-Medical and Psychological Treatments, Committee 14

INTRODUCTION

Since the millennium we have witnessed significant strides in the science and treatment of female sexual dysfunction (FSD). This forward progress has included (i) the development of new theoretical models to describe healthy and dysfunctional sexual responses in women; (ii) alternative classification strategies of female sexual disorders; (iii) major advances in brain, hormonal, psychological, and interpersonal research focusing on etiologic factors and treatment approaches; (iv) strong and effective public advocacy for FSD; and (v) greater educational awareness of the impact of FSD on the woman and her partner.

AIMS

To review the literature and describe the best practices for assessing and treating women with hypoactive sexual desire disorder, female sexual arousal disorder, and female orgasmic disorders.

METHODS

The committee undertook a comprehensive review of the literature and discussion among themselves to determine the best assessment and treatment methods.

RESULTS

Using a biopsychosocial lens, the committee presents recommendations (with levels of evidence) for assessment and treatment of hypoactive sexual desire disorder, female sexual arousal disorder, and female orgasmic disorders.

CONCLUSION

The numerous significant strides in FSD that have occurred since the previous International Consultation of Sexual Medicine publications are reviewed in this article. Although evidence supports an integrated biopsychosocial approach to assessment and treatment of these disorders, the biological and psychological factors are artificially separated for review purposes. We recognize that best outcomes are achieved when all relevant factors are identified and addressed by the clinician and patient working together in concert (the sum is greater than the whole of its parts). Kingsberg SA, Althof S, Simon JA, et al. Female Sexual Dysfunction-Medical and Psychological Treatments, Committee 14. J Sex Med 2017;14:1463-1491.

Maintaining Affection Despite Pain: Daily Associations Between Physical Affection and Sexual and Relationship Well-Being in Women with Genito-Pelvic Pain

Provoked vestibulodynia (PVD) is a recurrent, genito-pelvic pain condition that affects 8-12 % of women and has negative implications for sexual and relationship functioning. Many women with PVD report avoiding physical affection because they are concerned that affectionate behavior will lead to painful sexual activity. In community samples, physical affection is associated with improved sexual and relational well-being; however, no research has assessed the influence of physical affection on well-being in women with PVD. The current study examined day-to-day, within-person associations between affectionate behavior (hugging/kissing, cuddling) and sexual satisfaction, relationship satisfaction, sexual functioning, and pain intensity in women with PVD. Seventy women diagnosed with PVD completed an 8-week daily survey. Data were analyzed using multilevel modeling. All outcomes were assessed on days involving sexual activity (n = 401 days). Physical affection was assessed on days with and without sexual activity. Hugging/kissing was positively associated with sexual satisfaction, relationship satisfaction, and sexual functioning within any given day and when predicting the next day. Hugging/kissing was unrelated to pain intensity. Cuddling was not associated with any outcomes. Results persisted for affection that occurred on days with and without sexual activity. Findings suggest physical affection is beneficial for the sexual and relationship well-being of women with PVD. These results may inform interventions that encourage women coping with PVD to engage in more daily physical affection with their partners.

Factors associated with sexual health and well being in older adulthood

PURPOSE OF REVIEW

To provide an update of recent studies on factors associated with sexual well being in older people with a special focus on sexual activity, satisfaction and function.

RECENT FINDINGS

Most recent studies confirmed the relationship between mental health status, especially negative affect and depressive symptoms, and sexual health in older adulthood. However, when this relationship is investigated more deeply, it seems that in fact positive psychological well being (positive affect and quality of life) accounts for sexual activity rather than the lack of depressive symptoms. Moreover, recent studies provided more insight into the relationship between marital characteristics, religion, cognitive functioning and sleeping difficulties and different dimensions of sexual health in older adulthood.

SUMMARY

In summary, there is substantial previous research revealing associations between various psychosocial, health-related and demographic variables and sexual health in older adulthood. Most considered variables are, for example, age, sex, general physical and mental health. For future research, it is important to consider that relationships between specific variables and sexual health in higher age are usually more complex than they are expected to be and factors differ between different dimensions of sexual health. Communication about sexuality between health-care providers and older patients still implies a lot of barriers and lack of knowledge. Therefore, the provision of communication training for health-care providers to older people in which knowledge is gained about correlates of sexual health in older adulthood should be implemented.

Correlates of Sex Frequency and Sexual Satisfaction Among Partnered Older Adults

This study examines behaviors associated with sex frequency and sexual satisfaction in a national sample of partnered older adults, age 50 to 85 (N = 9,164), together for over one year. The results indicate that older adults with active and satisfying sex lives engage more frequently in open sexual communication and setting the mood for sexual activity. Additionally, synchronicity in sexual desire and activities is related to a high-frequency and highly satisfying sex life in older adulthood. An expansive sexual repertoire, as measured by the number of sexual activities used during the last sexual encounter and the incorporation of sexual variety, is also associated with greater sex frequency and sexual satisfaction.

Sexuality in Older Couples: Individual and Dyadic Characteristics

Sexuality is a key component of health and functioning that changes with age. Although most sexual activity takes place with a partner, the majority of research on sexuality has focused on individuals. In this paper, we focused on the sexual dyad. We proposed and tested a conceptual model of the predictors of partnered sexual activity in older adulthood. This model began with the personality of each of the partners, which affects individuals' views of sex and characteristics of the partnership, which in turn affected sexual expression in the couple. We measured a key feature of personality, Positivity, which reflected the individual's tendency to present his or herself positively in social situations. This trait, we posited, increased frequency of sex through increased desire for sex, and the subjective importance of sex to each member of the couple. In this model, Positivity also impacted characteristics of the relationship that promoted dyadic sexual behavior. These processes differed for men and women in the model. We tested this model with data from the National Social Life, Health and Aging Project, which conducted personal interviews with both partners in 940 American dyads (average male age 72; average female age 69). We found that couples in which the husbands' (but not wives') were high in Positivity show higher levels of sexual activity, and that this association was partially mediated by dimensions of relationship quality, but more so by individual factors such as thinking about sex and believing sex is important.

Sexuality and physical contact in National Social Life, Health, and Aging Project Wave 2

INTRODUCTION

Wave 2 of the National Social Life, Health, and Aging Project (NSHAP) includes new measures of sexual interest and behavior, as well as new measures of the context of sexual experience and the frequency and appeal of physical contact. This is the first time many of these constructs have been measured in a nationally representative sample.

METHOD

We describe the new measures and compare the distributions of each across gender and age groups, in some cases by partnership status.

RESULTS

Two components of sexuality decrease with age among both men and women: frequency of finding an unknown person sexually attractive and receptivity to a partner's sexual overtures. In contrast, the inclination to make one's self sexually attractive to others was a more complicated function of partner status, gender, and age: partnered women and unpartnered men made the most effort, with the more effortful gender's effort decreasing with age. Both men and women find nonsexual physical contact appealing but sexual physical contact is more appealing to men than women. Finally, two fifths of men and women report dissatisfaction with their partner's frequency of caring behaviors that make later sexual interactions pleasurable, and a fifth of women and a quarter of men who had vaginal sex in the past year report dissatisfaction with amount of foreplay.

DISCUSSION

These data offer the opportunity to characterize sexual motivation in older adulthood more precisely and richly and to examine how the context of sexual experience and the nonsexual aspects of physical intimacy correlate with sexual behavior, enjoyment, and problems.

Sexual activity and psychological health as mediators of the relationship between physical health and marital quality

OBJECTIVES

The pathways linking spousal health to marital quality in later life have been little examined at the population level. We develop a conceptual model that links married older adults' physical health and that of their spouse to positive and negative dimensions of marital quality via psychological well-being of both partners and their sexual activity.

METHODS

We use data from 1,464 older adults in 732 marital dyads in the 2010-2011 wave of the National Social Life Health and Aging Project.

RESULTS

We find that own fair or poor physical health is linked to lower positive and higher negative marital quality, spouse's health to positive quality, and that own and spouse's mental health and more frequent sex are associated with higher positive and lower negative marital quality. Further, we find that (a) sexual activity mediates the association between own and partner's physical health and positive marital quality, (b) own mental health mediates the association between one's own physical health and both positive and negative marital quality, and (c) partner's mental health mediates the associations of spouse's physical health with positive marital quality. These results are robust to alternative specifications of the model.

DISCUSSION

The results suggest ways to protect marital quality among older adults who are struggling with physical illness in themselves or their partners.

Sexual function, satisfaction with life and menopausal symptoms in middle-aged women

PURPOSE

To assess sexual function, satisfaction with life (SWL), and menopause-related symptoms among mid-aged Spanish women.

MATERIALS AND METHODS

Cross-sectional study of 260 women, aged 40-59, attending the public gynecology consultations completed the 14-item Changes in Sexual Functioning Questionnaire (CSFQ-14), the SWL Scale (SWLS), the Menopause Rating Scale (MRS), and a socio-demographic questionnaire.

RESULTS

Median [inter quartile range] age was 47 [8.0] years, 87.7% had a stable partner, 27.0% were postmenopausal, and 53.9% had increased body mass index (BMI). The prevalence of sexual dysfunction was 46.5% (CSFQ-14 score≤41). Postmenopausal status was associated with lower CSFQ-14 scores (worse sexual function) and severe menopausal symptoms whereas there were not significant differences in SWLS scores. CSFQ-14 scores correlated with SWLS (p<0.04), and inversely correlated with menopausal symptoms (p<0.02). Multiple linear regression analysis model predicted 26.6% of the total CSFQ-14 score variance, and higher scores (better sexual function) were correlated with better SWL, and inversely correlated to female age and worse menopausal symptoms. A second model predicted 38.4% of the SWLS score variance. The SWLS score correlated with the total CSFQ-14 score and BMI, and inversely correlated with economical problems, female tobacco use, lack of healthiness, menopausal symptoms, not having a partner, and partner's lack of healthiness.

CONCLUSIONS

Lower sexual function was related to low SWL, age and menopausal symptoms while low SWLS score was related with economical problems, smoking, menopausal symptoms, and partner factors.