Erectile dysfunction prevalence in the United States: report from the 2021 National Survey of Sexual Wellbeing.

BACKGROUND: There has been a great deal of public speculation regarding a surge in erectile dysfunction (ED) in younger men despite data consistently indicating that the ED prevalence rates increase with age. AIM: In this study we sought to assess the prevalence and risk of experiencing ED in a nationally representative sample of men in the United States across various social groups, describe comorbidities, and examine barriers to treatment. METHODS: Data from the 2021 National Survey of Sexual Wellbeing were analyzed by utilizing the Ipsos KnowledgePanel®, a probability-based online panel, for the purpose of obtaining US nationally representative data of adults aged 18 years and older. The analytic sample consisted of 1822 cisgender men ranging in age from 18 to 87 years, with a mean age of 47.5 years. OUTCOMES: Study outcomes were ED as measured by the 5-item version of the International Index of Erectile Function (IIEF-5), as well as self-reported diagnosis by a medical professional, comorbidities with other health issues, medications taken for ED, and barriers to treatment. RESULTS: The ED prevalence rate based on IIEF-5 scores was 24.2%. Prevalence increased with age: 52.2% of the 75+ age group, and 48.0% of the 65-74 age group meeting diagnostic criteria for ED. Diagnostic criteria were met for more participants in the 18-24 age group (17.9%) than the 25-34 (13.3%) or 35-44 (12.7%) age groups, but less than the 45-54 (25.3%) or 55-64 (33.9%) age groups. Only 7.7% (n = 141) of the sample reported having been diagnosed by a provider (n = 4 in 25-34, n = 6 in 35-44, n = 13 in 45-54, n = 39 in 55-64, n = 44 in 65-74, and n = 34 in ≥75-year olds), indicating a gap in access to treatment. The most common reason selected for not accessing care for ED concerns was a lack of need to see a provider in the past year. CLINICAL IMPLICATIONS: The discrepancy between ED self-report and medical diagnosis is critical, given that ED can be an indication of underlying health risks. STRENGTHS AND LIMITATIONS: This study is the first nationally representative update to information regarding the prevalence of ED in almost 2 decades. Standard administration of the IIEF-5 is limited to participants who have had sex in the last 6 months, so these rates do not include those men with ED who have been avoiding penetrative sex for a significant time. CONCLUSION: The results indicate that ED prevalence and severity remain highest in older age groups and that most individuals who meet criteria for ED have not sought medical care related to this concern.

Sexual Desire in the Time of COVID-19: How COVID-Related Stressors Are Associated with Sexual Desire in Romantic Relationships.

The COVID-19 pandemic and the resulting social distancing measures have caused widespread social and economic disruptions, resulting in spikes in unemployment and financial instability, along with drastic changes to people's ability to feel socially connected. Many of the changes resulting from the COVID-19 pandemic are risk factors for depressive symptoms, which are associated with lower levels of sexual desire. The current research (N = 4,993) examined whether responses to external stressors brought on by COVID-19 (i.e., financial concern, worry, loneliness, stress) were associated with sexual desire among a multi-national sample of people in relationships (Studies 1-2), and whether this association was, in part, due to reports of depressive symptoms (Study 2). In the period immediately following the onset of the pandemic, more financial concern (Study 1) and worry (Study 2) were associated with higher sexual desire, while other factors, like stress (Studies 1-2), were associated with lower desire. We also followed a subset of participants every two weeks during the initial stages of the pandemic and at times when people reported greater stress, loneliness, financial strain, or worry than their average, they reported greater depressive symptoms, which was, in turn, associated with lower sexual desire. Results suggest that the social isolation and stress resulting from the COVID-19 pandemic have mixed associations with sexual desire at the onset of the pandemic. But over time, when people report heightened COVID-related stressors, they tend to report lower sexual desire for their partner, in part because these stressors are associated with more depressive symptoms.

Uncovering the Most Important Factors for Predicting Sexual Desire Using Explainable Machine Learning.

BACKGROUND: Low sexual desire is the most common sexual problem reported with 34% of women and 15% of men reporting lack of desire for at least 3 months in a 12-month period. Sexual desire has previously been associated with both relationship and individual well-being highlighting the importance of understanding factors that contribute to sexual desire as improving sexual desire difficulties can help improve an individual's overall quality of life. AIM: The purpose of the present study was to identify the most salient individual (eg, attachment style, attitudes toward sexuality, gender) and relational (eg, relationship satisfaction, sexual satisfaction, romantic love) predictors of dyadic and solitary sexual desire from a large number of predictor variables. METHODS: Previous research has relied primarily on traditional statistical models which are limited in their ability to estimate a large number of predictors, non-linear associations, and complex interactions. We used a machine learning algorithm, random forest (a type of highly non-linear decision tree), to circumvent these issues to predict dyadic and solitary sexual desire from a large number of predictors across 2 online samples (N = 1,846; includes 754 individuals forming 377 couples). We also used a Shapley value technique to estimate the size and direction of the effect of each predictor variable on the model outcome. OUTCOMES: The outcomes included total, dyadic, and solitary sexual desire measured using the Sexual Desire Inventory. RESULTS: The models predicted around 40% of variance in dyadic and solitary desire with women's desire being more predictable than men's overall. Several variables consistently predicted dyadic sexual desire such as sexual satisfaction and romantic love, and solitary desire such as masturbation and attitudes toward sexuality. These predictors were similar for both men and women and gender was not an important predictor of sexual desire. CLINICAL TRANSLATION: The results highlight the importance of addressing overall relationship satisfaction when sexual desire difficulties are presented in couples therapy. It is also important to understand clients' attitudes toward sexuality. STRENGTHS & LIMITATIONS: The study improves on existing methodologies in the field and compares a large number of predictors of sexual desire. However, the data were cross-sectional and there may have been variables that are important for desire but were not present in the datasets. CONCLUSION: Higher sexual satisfaction and feelings of romantic love toward one's partner are important predictors of dyadic sexual desire whereas regular masturbation and more permissive attitudes toward sexuality predicted solitary sexual desire. Vowels LM, Vowels MJ, Mark KP. Uncovering the Most Important Factors for Predicting Sexual Desire Using Explainable Machine Learning. J Sex Med 2021;18:1198-1216.

"Not Tonight, Honey:" Reasons Couples Do Not Engage in Sex and Their Impact on Satisfaction and Desire.

INTRODUCTION: Sexual activity is an important aspect of most romantic relationships. However, many couples report declines in sexual activity over time and report many reasons for not engaging in sexual activity on a daily basis. AIM: To investigate the reasons for not engaging in sexual activity in couples over a month and whether these reasons are associated with sexual and relationship satisfaction and sexual desire. METHODS: We collected 30-day daily electronic report data from 174 individuals (87 mixed-sex couples). The responses between men and women were analyzed using chi-squared tests, and we used multilevel modeling to examine the association between the reasons and satisfaction and desire. MAIN OUTCOME MEASURE: The main outcome measure includes daily sexual satisfaction, relationship satisfaction, and sexual desire. Daily reported reasons for not engaging in sexual activity are categorized into joint reason, self-based reason, partner-based reason, and other reasons. RESULTS: Men and women were equally likely to endorse joint reasons for not engaging in sexual activity (eg, "It just didn't happen"), whereas women were more likely to endorse self-based reasons (eg "I wasn't in the mood") and men partner-based reasons (eg "My partner was tired"). The reasons for not engaging in sexual activity were associated with daily sexual and relationship satisfaction and daily sexual desire. Higher baseline sexual desire was associated with a greater likelihood of endorsing partner-related reasons and smaller likelihood of endorsing self-related reasons. Higher baseline sexual satisfaction was associated with a decreased likelihood of reporting partner-based reasons, and higher baseline relationship satisfaction was associated with an increased likelihood of reporting joint reasons. Some of the other associations were significant only for men or women. CLINICAL IMPLICATIONS: Results inform couples' therapy and other clinical interventions and highlight the importance of addressing the reasons for not engaging in sexual activity to find ways of mitigating some of these reasons. STRENGTH & LIMITATIONS: The study was the first to date to address reasons for not engaging in sexual activity in a sample of couples in an experience-sampling study. However, our scope was limited to mixed-sex couples who were primarily white and heterosexual, and we only addressed reasons for not engaging in partnered sex (not solitary sex). CONCLUSION: The reasons for not engaging in sexual activity seem different for men and women and are associated with sexual and relationship satisfaction and sexual desire, and this link appears to be bidirectional. Mark KP, Vowels LM, Leistner CE. "Not Tonight, Honey:" Reasons Couples Do Not Engage in Sex and Their Impact on Satisfaction and Desire. J Sex Med 2020;17:431-441.

Partners' Daily Love and Desire as Predictors of Engagement in and Enjoyment of Sexual Activity.

Romantic love and sexual desire have often been seen as two distinct constructs and studied separately. However, in most romantic relationships love, desire, and sex are intertwined. The purpose of the present study was to examine whether daily feelings of love and desire influence engagement in and enjoyment of sexual activity. Ninety mixed-sex couples (N = 180) completed a 30-day daily diary. The results were analyzed using hierarchical linear modeling and showed that both love and desire significantly predicted engagement in and enjoyment of sexual activity with desire being a stronger predictor. Clinical implications and future directions are discussed.

Positive Communication and Partner Appraisals Among Mothers and Their Long-Term Male Partners: Impact on Sexual and Relationship Satisfaction.

Parents in the USA struggle to maintain their sexual and relational health over time. The current study aimed to investigate the impact of positive communication and partner appraisals on sexual and relationship satisfaction in a sample of 93 mixed sex couples (N = 186) with children living in the home on a full-time basis. Results indicated that for men and women, positive communication scores predicted higher levels of sexual and relationship satisfaction and more positive partner appraisals predicted higher levels of relationship satisfaction. Significant results were also found at the couple-level. Findings have clinical and educational implications for parents.

Ebbs and Flows of Desire: A Qualitative Exploration of Contextual Factors Affecting Sexual Desire in Bisexual, Lesbian, and Straight Women.

Previous research has found that sexual desire ebbs and flows over time within and across relationships, leading to instances of desire discrepancy. The purpose of the present study was to understand factors that may contribute to desire and desire discrepancy and examine differences and similarities across women from diverse sexual identity groups. The present qualitative study involved semi-structured interviews with 31 women (10 bisexual, 8 lesbian, and 13 straight). We identified six main themes (changes across lifespan, hormonal influences, mental and physical health, objective of desire, partner dynamics, external factors) with 21 subthemes. The findings showed more similarities between the women than differences.

Strategies for Mitigating Sexual Desire Discrepancy in Relationships.

Sexual desire discrepancy, when one member of a couple experiences more or less sexual desire relative to their partner, is among the main reasons for couples to seek therapy. A great deal of prior research has examined the complexity of sexual desire and the role of sexual desire discrepancy in long-term relationships, but little research has specifically examined strategies used to mitigate sexual desire discrepancy when it arises. Thus, the purpose of the present mixed methods study was to identify the strategies that individuals in long-term relationships use during times of desire discrepancy and to address whether the use of specific strategies influenced sexual and relationship satisfaction and sexual desire. We collected data from 229 participants and our thematic content analysis produced 17 strategies, divided into five main groups (disengagement, communication, engagement in activity alone, engagement in other activity with partner, and have sex anyway). Specific strategies were associated with sexual and relationship satisfaction but not with sexual desire. Specifically, partnered strategies were associated with higher levels of sexual and relationship satisfaction compared to individual strategies. Additionally, participants who reported that their strategies were very helpful had higher levels of sexual and relationship satisfaction compared to participants who found them somewhat helpful followed by not at all helpful. These results have implications for clinicians, educators, and researchers and highlight the importance of using effective strategies to deal with desire discrepancy and communicating about them in relationships. The use of effective strategies can have implications for overall couple well-being.

Daily Sexual Desire and Its Impact on Next-Day Desire and Behavior in Mixed Sex Couples.

Sexual desire contributes to overall sexual and relational health among long-term romantic partnerships. However, little research has examined the nuances of partner-level sexual desire and behavior on a daily level, despite evidence that it ebbs and flows and is more of a state than a static characteristic. Additionally, daily sexual behavior and desire may impact women differently than men. Therefore, understanding individual and partner-level dynamics among men and women may provide a more nuanced understanding of sexual desire as a situational state in the context of long term couples. A sample of 87 mixed-sex couples (174 individuals; M age = 33 years) in long-term relationships (M = 9.33 years) completed a daily electronic report for 30 days and reported on their daily sexual desire and sexual behavior. A series of four stability influence actor partner interdependence models were conducted to investigate the individual and partner-level link between men and women's daily levels of sexual desire and their sexual behavior and desire the following day. Findings indicated that daily sexual desire fuels sexual desire on the following day, particularly for men, regardless of whether sexual behavior was engaged in. Additionally, sexual desire on one day impacts next-day desire for partners, particularly on days when sexual behavior occurred. Contextual, partner-level contributing factors seem to have the largest impact on daily levels of sexual desire among long-term couples. Implications and future research directions are discussed.

The Impact of Attachment Style on Sexual Satisfaction and Sexual Desire in a Sexually Diverse Sample.

Research has indicated that adult romantic attachment is influential and important to sexual and relationship satisfaction. Sexual desire, although not a direct focus of attachment literature, is highly related to sexual and relationship satisfaction, suggesting it may also be impacted by attachment style in romantic couples. However, the research conducted on sexual desire, sexual satisfaction, and attachment has been largely heterocentric, making it difficult to determine whether the findings documented in the literature thus far are relevant in a sexually diverse group of individuals. The current study aimed to better understand the way that attachment style may impact sexual desire, sexual satisfaction, and relationship satisfaction in a sample of sexually diverse men and women. In total, 955 individuals (63.4% cisgender women, 30.7% cisgender men, 6.0% genderqueer, 54.8% straight, 20.4% bisexual, 18.4% gay) participated in a web-based study examining relationship dynamics. Three multivariate regression models indicated that attachment style significantly predicted relationship satisfaction (29% of variance accounted for), sexual satisfaction (19% of variance accounted for), and sexual desire (4% of variance accounted for). Attachment style appears to be a more important contributing factor to satisfaction than desire among diverse sexual orientations. Clinical implications and future directions are discussed.

Comparing 3-month recall to daily reporting of sexual behaviours.

OBJECTIVES: This study aimed to examine discrepancies between self-report methods and methodological issues related to sexual risk taking. We examined sexual behaviour assessed via 3-month electronic recall and by daily electronic reporting among a large cohort of patients attending STI clinics. METHODS: STI clinic attenders (N= 628) aged 15 to 60 years reported on demographic information (at baseline), penile-vaginal sex acts, condom-unprotected penile-vaginal sex and STI history using 3-month recall and daily reports. Additionally, interviewer-participant match related to race and gender, as well as study site were considered as covariates. RESULTS: Concordance between recall and daily reports on penile-vaginal sex was moderately strong (Spearman's r (rs)=0.62; p<0.001). Comparison for reports for condom-unprotected penile-vaginal sex resulted in a correlation coefficient of 0.61 (p<0.001), also indicating moderately strong agreement between the two methods. Two generalised logit models were conducted to explain lack of strong concordance in penile-vaginal sex acts and condom-unprotected penile-vaginal sex. The odds of a female reporting higher frequency of sex in daily reports compared with recall were more than two times that of a male. Every five person increase in the number of lifetime sexual partners was associated with five times the odds of a discrepancy in reporting methods. Age was also significantly associated with unequal daily versus recall sex frequency reporting. CONCLUSIONS: Shifting focus to methodological considerations of technological reports can help ensure better investment of resources into sexual health research due to greater understanding of the methodological properties of data collection methods.

Impact of Contraceptive Type on Sexual Desire of Women and of Men Partnered to Contraceptive Users.

INTRODUCTION: Research investigating the impact of contraceptive use on sexual desire has produced mixed results. This scholarship also has had inconsistent methodology, with some studies not separating contraceptive types and others lacking non-hormonal comparison groups. Relationship context of contraceptive use and sexual behavior also have not been well represented. AIMS: To investigate the impact of contraceptive type on sexual desire in women and in men who are partnered to contraceptive-using women. METHODS: In two separate studies we examined the impact of contraceptives on the sexual desire of women currently using contraceptives and men partnered to women using contraceptives. The first study examined the impact of contraceptive type on sexual desire in women and in men partnered to contraceptive users in relationships of different lengths. The second study examined this impact in heterosexual couples in long-term relationships. MAIN OUTCOME MEASURES: Solitary and dyadic sexual desire as measured by the Sexual Desire Inventory and contraceptive type as categorized into three types: oral hormonal contraceptive, other hormonal contraceptive, and non-hormonal contraceptive. RESULTS: Contraceptive type significantly affected solitary and dyadic desire. Women on non-hormonal contraceptives reported higher solitary sexual desire than women on other hormonal contraceptives. Women on oral hormonal contraceptives reported significantly higher dyadic sexual desire than women on non-hormonal contraceptives. In male partners of female contraceptive users, solitary and dyadic sexual desires were not affected by partner contraceptive type. In the multivariate model, relationship length and age were stronger predictors of contraceptive type than was solitary or dyadic sexual desire. At the couple level, contraceptive type also was not related to solitary or dyadic sexual desire in men and women. CONCLUSION: Contraceptive type can affect solitary and dyadic sexual desire in women; however, contextual factors seem to be stronger predictors of sexual desire for long-term coupled women and men than contraception type.

The influence of attraction to partner on heterosexual women's sexual and relationship satisfaction in long-term relationships.

Previous research has consistently found that attraction is important in the formation of relationships though research on attraction in long-term relationships is less well understood. This article examined the predictive value of self-reported attraction to partner and change in attraction to partner on sexual and relationship satisfaction in 176 women in committed heterosexual relationships using online survey methodology. Participants' age ranged from 21 to 56 (M = 34.5) years and their relationship length ranged from 5 to 35 (M = 11.75) years. Hierarchical multiple regression results indicated that change in attraction to partner was the most salient predictor of sexual satisfaction, with current attraction to partner also related to women's sexual satisfaction, accounting for 20 % of the variance. Current attraction to partner was the only significant predictor of women's relationship satisfaction, accounting for 22 % of the variance. Additionally, attraction variables accounted for variance above and beyond the impact of relationship and sexual satisfaction. These findings suggest that self-reported attraction to partner is an important contributor to women's satisfaction outcomes in long-term relationships. Further studies in the area of attraction to partner that include couple dynamics and longitudinal data are encouraged and implications for therapists, clinicians, and educators are discussed.

The Impacts of Lifetime Violence on Women's Current Sexual Health.

Background: Intimate partner violence (IPV), nonpartner sexual violence (SV), child sexual and physical abuse, and neglect have detrimental impacts on women's reproductive and sexual health. More empirical studies are needed to investigate the negative impacts of lifetime violence, including physical or sexual child abuse, nonpartner SV, physical, sexual, and psychological IPV on women's sexual health to better understand long-term impacts from IPV and physical or sexual child abuse. Materials and Methods: We used data from Wellness, Health and You, an ongoing health registry. A total of 1,213 women were included in data analysis. Our aim was to investigate the associations between lifetime IPV, nonpartner SV, child abuse, and women's current sexual health defined using Patient-Reported Outcomes Measurement Information System (PROMIS) measures of sexual health (e.g., sexual satisfaction, interest, and functioning), sexual assertiveness, female sexual subjectivity, and use of online resources to address sexual needs. Multivariate analysis of covariance was used to investigate demographic factors (e.g., age and current relationship) as potential correlates of current sexual health. Results: Women with lifetime experiences of physical, sexual, or psychological IPV, nonpartner SV, and child physical or sexual abuse reported lower sexual satisfaction compared to women with no history of lifetime violence (p < 0.0001). However, lifetime violence was not correlated with sexual interest, sexual functioning, sexual subjectivity, nor sexual assertiveness. Conclusion: Lifetime experiences of violence (i.e., IPV, nonpartner SV, child abuse) are associated with poorer sexual health. Asking questions about past sexual and physical violence/abuse in ways that support disclosure is important toward improving women's physical and sexual health and wellbeing.

Women Who Experience More Affectionate Touch Report Better Body Satisfaction and Relationship Outcomes.

Affectionate touch (e.g. hugging, handholding) is an essential component of many intimate relationships and is a primary contributor to overall relationship satisfaction as well as sexual satisfaction. Affectionate touch is understood to be a form of non-verbal communication in which the giver is expressing positive feelings toward the receiver. Here, we propose that affectionate touch also positively impacts receivers' body satisfaction, because affectionate touch is a positive message communicated toward the receiver's body. In a cross-sectional sample of romantically partnered women (N = 1,156), we assessed the association between affectionate touch frequency and body satisfaction. We also investigated whether affectionate touch is associated with relationship/sexual satisfaction in part because touch helps to improve women's evaluations of their own bodies. Our results showed that body satisfaction was a significant, partial mediator and a valid path through which affectionate touch shapes relationship quality. Receiving affectionate touch could bolster relationship satisfaction and self-perceptions among women. Given the prevalence of body dissatisfaction amongst women, these results suggest that the underexplored associations between affectionate touch and body satisfaction may have significant impacts on a wide array of future empirical and applied research trajectories.

The mediating role of sexual and nonsexual communication between relationship and sexual satisfaction in a sample of college-age heterosexual couples.

This study aimed to examine in a sample of college-age heterosexual couples the relations between (a) relationship and sexual satisfaction and (b) sexual and nonsexual communication. The authors tested a mediation model whereby couples' relationship satisfaction was hypothesized to predict couples' sexual satisfaction by way of sexual and nonsexual communication levels. Participants were 266 individuals (133 couples) who completed measures of satisfaction and communication independently of their partner. A mediation model, tested with structural equation modeling, showed the degree to which couples were relationally satisfied was positively related to their level of sexual and nonsexual communication, which, in turn, was positively associated with their degree of sexual satisfaction. Results indicate that levels of sexual and nonsexual communication among couples affect the link between relationship and sexual satisfaction. Such findings may have important implications for college-age couples in committed relationships who are looking to improve satisfaction as well as for therapists, counselors, and educators who work with these couples to improve relationship and/or sexual satisfaction.

Understanding problems with condom fit and feel: an important opportunity for improving clinic-based safer sex programs.

The purpose of this study was to investigate gender differences and other demographic correlates of condom fit and feel problems among a diverse sample of adult condom users and to examine men's and women's perceptions and experiences with condom fit and feel problems. Participants were recruited from an electronic mailing list. The analytic sample (N = 949) included self-identified heterosexual men (n = 771) and women (n = 178) who reported using condoms for penile-vaginal or penile-anal intercourse in the past 3 months. Both quantitative and qualitative methods were applied. Of the sample, 38.3% reported experiencing at least one condom fit or feel problem. Problems with condom fit during sex did not differ significantly by gender (p = .73). Perceptions of specific condom use problems were organized into five themes: (1) decreased sensation, (2) lack of naturalness, (3) condom size complaints, (4) decreased pleasure, and (5) pain and discomfort. In this diverse sample, there was a high prevalence of condom fit and feel issues among women as well as men. These issues, mostly focused on loss of pleasure, represent a substantial public health problem and thus warrant attention in safer sex programs.

Attitudes toward Mothers as Sexual Beings (ATMSB): Scale Development and Associations with Satisfaction and Desire among Parents with Young Children.

Societal messages about mothers indicate an incompatibility between motherhood and sexuality and women report not feeling like sexual beings after transitioning into parenthood. Research shows that negative sexual attitudes are associated with worse sexual function, indicating that negative attitudes toward mothers as sexual beings may negatively impact the sexual health of mothers and their partners. However, there is no existing tool to measure sexual attitudes about mothers. The aim of this study was to develop a tool to measure attitudes toward mothers as sexual beings (ATMSB) and examine associations with sexual satisfaction, relationship satisfaction, and desire among men and women with small children. Men and women with their first child no older than 5 (N = 481) were recruited from Qualtrics Panels. Results indicated that the ATMSB scale is a reliable and valid 11-item tool for measuring attitudes about mothers as sexual beings. The scale has two subscales, one on sexuality and quality of mothering and another on mothers' sexual interests and behaviors. ATMSB scores were associated with sexual satisfaction, relationship satisfaction and desire for men and women with young children. This scale has implications for sex research and clinical practice addressing issues that are relevant to mothers and their partners.