Patients' Conceptions of Terms Related to Sexual Interest, Desire, and Arousal.

BACKGROUND: Measurement of sexual function typically uses self-report, which, to work as intended, must use language that is understood consistently by diverse respondents. Commonly used measures employ multiple terms, primarily (sexual) interest, desire, and arousal, that might not be understood in the same way by laypeople and professionals. AIM: To inform self-reported measurement efforts for research and clinical settings by examining how US men and women recruited from a health care setting understand and interpret different terms. METHODS: We conducted 10 focus groups in Durham, NC (N = 57). Discussions were audio-recorded and transcribed, and the content of the discussions was systematically analyzed in 2 phases of coding by the research team, facilitated by Nvivo qualitative analysis software (QSR International, Doncaster, VIC, Australia). OUTCOMES: Patient focus group discussions about the meanings and connotations of multiple terms related to sexual function, especially interest, desire, and arousal. RESULTS: 5 groups included male participants and 5 included female participants. Participants characterized (sexual) interest as a cognitive phenomenon and a situational response to a specific person. Similarly, they characterized (sexual) desire as a situational person-specific experience with some support for it as a cognitive phenomenon but more support for it as a physical phenomenon. In contrast, participants characterized sexual arousal as a physical phenomenon occurring in response to physical or visual stimulation and not related to a specific person. CLINICAL IMPLICATIONS: These results can help us understand how laypeople are using and responding to these terms when they are used in clinical and research settings. STRENGTHS AND LIMITATIONS: Patient participants in these groups were diverse in age, gender, sexual orientation, and health, with the potential to voice diverse perspectives on sexual functioning; however, the sample was limited to a single city in the southeastern United States. CONCLUSION: The meanings of interest, desire, and arousal were defined, compared, and contrasted in the context of patient focus groups. Qualitative coding showed that interest was considered the most "cognitive," arousal the most "physical," and desire somewhere in between. DeLamater JD, Weinfurt KP, Flynn KE. Patients' Conceptions of Terms Related to Sexual Interest, Desire, and Arousal. J Sex Med 2017;14:1327-1335.

Lies, Damned Lies, and Survey Self-Reports? Identity as a Cause of Measurement Bias.

Explanations of error in survey self-reports have focused on social desirability: that respondents answer questions about normative behavior to appear prosocial to interviewers. However, this paradigm fails to explain why bias occurs even in self-administered modes like mail and web surveys. We offer an alternative explanation rooted in identity theory that focuses on measurement directiveness as a cause of bias. After completing questions about physical exercise on a web survey, respondents completed a text message-based reporting procedure, sending updates on their major activities for five days. Random assignment was then made to one of two conditions: instructions mentioned the focus of the study, physical exercise, or not. Survey responses, text updates, and records from recreation facilities were compared. Direct measures generated bias-overreporting in survey measures and reactivity in the directive text condition-but the nondirective text condition generated unbiased measures. Findings are discussed in terms of identity.

Sexual functioning in older adults.

This article reviews recent medical and social science literature on sexual functioning in older adults. We provide a broad definition of sexual functioning that includes a range of solo and partnered forms of sexual expression. We identify four determinants of sexual functioning: biologic, psychological, social context (including culture), and interactions of these with each other. Recent literature on the impact of aging and physical health documents some decline in frequency of sexual activity. Interest continues in the role of hormones in male and female sexual functioning. Recent research highlights the role of the social context, especially the presence of a sexual partner and the relationship with that partner, in sexual activity. We discuss variations in sexual functioning by life course events, gender, and race and ethnicity. Relevant results from the Global Study of Sexual Attitudes and Behaviors; Male Attitudes Regarding Sexual Health Survey; and the National Social Life, Health and Aging Project are also reviewed.

Sexual satisfaction in the seventh decade of life.

This research presents data on the sexuality of men and women in their mid-sixties. The data are from the Wisconsin Longitudinal Study 2003 mail survey; analyses include 2156 men and 1955 women. Respondents reported having sex 1.7 times per month. Regression analyses were used to identify variables associated with sexual behavior and satisfaction. Included were measures of physical health, sexual functioning, psychological distress, and satisfaction with the relationship. Frequency of sexual activity was significantly predicted by reports that partner lost interest in sex. Satisfaction with the sexual relationship was predicted by marital/ relationship satisfaction and frequency of sexual activity. Sexual expression remains a significant aspect of intimate relationships in the seventh decade of life.

Sexual behavior in later life.

OBJECTIVE: This research tests the influences of age, biological, and psychosocial factors on sexual expression in later life. METHOD: The American Association of Retired Persons Modern Maturity Sexuality Survey collected data on diagnosed illnesses, treated illnesses, sexual desire, sexual attitudes, partner circumstances, and sexual behavior from 1,384 persons ages 45 and older. Ordered logistic regression models estimate the associations of age, biological, and psychosocial factors with the frequency of five sexual behaviors. RESULTS: Diagnosed illnesses and treatments are generally unrelated to frequency of sexual activity. Sexual attitudes are related to frequency of partnered behavior and sexual desire is related to frequency of masturbation among both women and men. Satisfaction with the physical relationship with a partner is strongly related to behavior. Age remains significant after all other factors are controlled. DISCUSSION: The authors conclude that the nature of sexual expression in later life reflects the interplay of body, mind, and social context.

Sexual desire in later life.

The has been relatively little research on sexuality in later life, particularly among persons over 60 years of age. The existing literature consists of studies of small samples, much of it from a biomedical perspective. This literature suggests that age, hormone levels, specific illnesses, and various medications negatively affect sexual functioning in older persons. The study reports results from a survey of a large sample (N=1,384) of persons age 45 and older that included measures of a variety of biological, psychological and social factors that potentially influence sexual functioning. We report bivariate and multivariate analysis conducted separately for women and men. We find that the principal influences on strength of sexual desire among women are age, the importance of sex to the person, and education. In this sample of the population of older persons, attitudes are more significant influences on sexual desire than biomedical factors.

Context counts: long-term sequelae of premarital intercourse or abstinence.

An individual's first sexual experience is a highly salient and meaningful event, with potential to shape sexual scripts and the affect associated with sexual expression. Using data from the National Health and Social Life Survey, we tested abstinence-only advocates; assertions that premarital sex results in psychological and physical harm such as sexual dysfunction, sex guilt, poor health, sexually transmitted diseases, and poor life satisfaction. The first vaginal intercourse was premarital in 82.9% of the sample. Average age at first intercourse was 17.7 years. Relationship status as first intercourse was not consistently associated with later psychological or physical health outcomes. If the first experience was prepubertal, forced, with a blood relative or stranger, or the result of peer pressure, drugs, or alcohol, poorer psychological and physical health outcomes in adulthood were reported consistently. There is little evidence that premarital sex per se is disastrous for later sexual functioning or sex guilt; insofar as first sexual experiences are related to later functioning, the context of the experience is the crucial element.

Human sexual development.

Empirical research by scholars from several disciplines provides the basis for an outline of the process of sexual development. The process of achieving sexual maturity begins at conception and ends at death. It is influenced by biological maturation/aging, by progression through the socially-defined stages of childhood, adolescence, adulthood, and later life, and by the person s relationships with others, including family members, intimate partners, and friends. These forces shape the person's gender and sexual identities, sexual attitudes and sexual behavior. Adults display their sexuality in a variety of lifestyles, with heterosexual marriage being the most common. This diversity contributes to the vitality of society. Although changes in sexual functioning in later life are common, sexual interest and desire may continue until death.

Sexual expression in later life: a review and synthesis.

In the past decade, researchers have begun to study the sexual functioning of typical older persons. This review summarizes literature on the sexuality of men and women over age 50 as researched by social and health scientists. Research on the relationship of biological factors (changes accompanying aging), health (physical, mental, and medication use), psychological factors (attitudes, information about sex), relationship factors (status, satisfaction), and sexual functioning (desire, dysfunctions, treatment) to sexual behavior is reviewed. The review suggests that (a) men and women remain sexually active into their 70s and 80s, (b) aging-related physical changes do not necessarily lead to decline in sexual functioning, and (c) good physical and mental health, positive attitudes toward sex in later life, and access to a healthy partner are associated with continued sexual activity. In turn, regular sexual expression is associated with good physical and mental health. Progress in understanding later life sexuality requires development of comprehensive theoretical models, a broad focus on intimacy, attention to measures and samples, and research on couples. Progress in understanding is especially important, given the aging of populations.

Sexual frequency decline from midlife to later life.

OBJECTIVE: To examine sexual frequency decline among American men and women between the ages of 44 and 72 born from 1933 to 1948. METHOD: Using data from the National Health and Social Life Survey (NHSLS) and the National Social Life, Health, and Aging Project (NSHAP), the decline in sexual frequency is decomposed into declines due to changes in marital status, physical health, and happiness. We examine the contribution of both changes in the composition of the population with respect to these factors as well as changes in the association between these factors and sexual frequency by age. RESULTS: For women, change in the proportion widowed is a significant factor in sexual frequency decline, as is change in the association between happiness and sexual frequency. Among men, both poorer physical health at older ages and a decrease in its association with frequency are significant factors in the decline. A change in the association between happiness and frequency is also a significant factor for men. Reverse causality may explain the happiness-frequency findings for both men and women. DISCUSSION: Results provide evidence for gendered experiences in the sexual life course.