Associations between health and sexual lifestyles in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Abstract

SummaryBackgroundPhysical 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).MethodsMen 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.FindingsInterviews were done with 15 162 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: 35·7% [95% CI 28·6–43·5] vs 74·8% [72·7–76·7]; women: 34·0% [28·6–39·9] vs 67·4% [65·4–69·3]), and this association remained after adjusting for age and relationship status (men: adjusted odds ratio [AOR] 0·29 [95% CI 0·19–0·44]; women: 0·43 [0·31–0·61]). 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: 45·4% [38·4–52·7] vs 69·5% [67·3–71·6], AOR 0·51 [0·36–0·72]; women: 48·6% [42·9–54·3] vs 65·6% [63·6–67·4], AOR 0·69 [0·53–0·91]). 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. 16·6% (95% CI 15·4–17·7) of men and 17·2% (16·3–18·2) 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. 23·5% (20·3–26·9) of men and 18·4% (16·0–20·9) 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).InterpretationPoor 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.FundingGrants f...

Sexual Health and Well-being Among Older Men and Women in England: Findings from the English Longitudinal Study of Ageing

“…Some population-based surveys have specifically examined the importance of sexuality with respect to health and wellbeing, with studies from both the US (Lindau et al, 2007) and UK (Mercer, Tanton, et al, 2013;Mitchell et al, 2013) indicating that many older adults are engaged in intimate relationships and regard sexuality as an important part of life. While it is recognized that sexuality in later life is influenced by physiological, situational and attitudinal dimensions (Morley & Tolson, 2012), little is known about how sexuality relates to the ageing process more generally.…”

Socio-cultural influences upon knowledge of sexually transmitted infections: a qualitative study with heterosexual middle-aged adults in Scotland

“…5,6 In addition, within the UK, around 80% of adult life is spent in very good or good health which is associated with being more sexually active than when in poor health. [7][8][9],* Large scale UK-based survey data indicates that 77.7% of men and 53.7% of women from age 50 to over 90 were sexually active in the last year. 9 The sexual domain of healthy ageing remains a largely underexplored area, lacking relevant evidence to shape intervention design and service provision.…”

Sexual function and ageing

“…To date, the two largest studies on sexual health and function that include older persons are the National Social Life, Health, and Aging Project (NSHAP) [1] in the USA and the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) [5] in the UK.…”

“…The Natsal-3 reported that men and women with a longstanding illness, ≥2 chronic conditions, a BMI >35 kg/m 2 or who walk up stairs with difficulty due to a health problem were significantly less likely to report sexual activities in the prior 4 weeks than those who did not report these issues. [5] Depression, coronary artery disease, renal failure, lower urinary tract symptoms in women, hyperprolactinaemia, diabetes mellitus, primary or secondary hypogonadism in men, and neurological diseases, e.g. cerebrovascular disease and Parkinson's disease, are all associated with reduced sexual desire and arousal.…”

“…[10] Vaginal dryness has been associated with a previously fractured hip or pelvis, a hip replacement, depressive symptoms, being postmenopausal, and having backache or bone disease for >3 months in the past year. [5] In postmenopausal older women, vulvovaginal atrophy (VVA) is a progressive problem, which is unlikely to resolve without treatment. [11] Surveys have found that 19 -27% of women report dryness, irritation or itching.…”