Men with Sexual Problems and Their Partners: Findings from the International Survey of Relationships.

Epidemiologic studies of sexual function problems in men have focused on the individual male and related sociodemographic characteristics, individual risk factors and lifestyle concomitants, or medical comorbidities. Insufficient attention has been given to the role of sexual and relationship satisfaction and, more particularly, to the perspective of the couple as causes or correlates of sexual problems in men or women. Previously, we reported results of the first large, multi-national study of sexual satisfaction and relationship happiness in 1,009 midlife and older couples in five countries (Brazil, Germany, Japan, Spain, U.S.). For the present study, we examined, within each problem, the association of four major sexual problems in men (loss of sexual desire, erectile problems, premature ejaculation, delayed/absent orgasm) and multiple problems, with male and female partners' assessments of physical intimacy, sexual satisfaction, and relationship happiness, as well as associations with well-known health and psychosocial correlates of sexual problems in men. Sexual problem rates of men in our survey were generally similar to rates observed in past surveys in the general population, and similar risk factors (age, relationship duration, overall health) were associated with lack of desire, anorgasmia, or erection difficulties in our sample. As in previous surveys, there were few correlates of premature ejaculation. As predicted, men with one or more sexual problems reported decreased relationship happiness as well as decreased sexual satisfaction compared to men without sexual problems. Moreover, female partners of men with sexual problems had reduced relationship happiness and sexual satisfaction, although these latter outcomes were less affected in the women than the men. The association of men's sexual problems with men's and women's satisfaction and relationship happiness were modest, as these couples in long-term, committed relationships were notable for their relatively high levels of physical affection and relationship happiness.

Individual and Partner Correlates of Sexual Satisfaction and Relationship Happiness in Midlife Couples: Dyadic Analysis of the International Survey of Relationships.

The current research reports a dyadic analysis of sexual satisfaction, relationship happiness, and correlates of these couple outcomes in a large multinational dataset consisting of 1,009 midlife heterosexual couples (2,018 individuals) recruited in Japan, Brazil, Germany, Spain, and the United States (Heiman et al., 2011). Actor-Partner Interdependence Models (Kenny, Kashy, & Cook, 2006) identified correlates of sexual satisfaction that included individuals' reports of good health; frequent kissing, cuddling, and caressing; frequent recent sexual activity; attaching importance to one's own and one's partner's orgasm; better sexual functioning; and greater relationship happiness. Even after controlling for individual-level effects, partners' reports of good health; frequent kissing, cuddling, and caressing; frequent recent sexual activity; attaching importance to one's own and one's partner's orgasm; better sexual functioning; and greater relationship happiness contributed significantly to predicting and understanding individuals' sexual satisfaction. Correlates of relationship happiness included individuals' reports of good health; frequent kissing, cuddling, and caressing; frequent recent sexual activity; attaching importance to one's own and one's partner's orgasm; better sexual functioning; and greater sexual satisfaction, and once again, even after controlling for individual-level effects, partners' reports of each of these correlates contributed significantly to predicting and understanding individuals' relationship happiness. Interactions of individual and partner effects with participant gender are also reported. Current results demonstrate empirically that the partner "matters" to an individual's sexual satisfaction and relationship happiness and indicate that a comprehensive understanding of factors contributing to these couple outcomes requires a couple-level research strategy. Partner effects, even when controlling for individual effects, were consistently observed, and explanation of sexual satisfaction and relationship happiness always depended on identifying and understanding mutual and concurrent individual and partner influences.

Correlates of PDE5i use among subjects with erectile dysfunction in two population-based surveys.

INTRODUCTION: Erectile dysfunction (ED) is thought to affect some 150 million men worldwide, but many men with ED symptoms do not seek treatment. Existing surveys suggest that men with severe ED and who report support from their partners are more likely to receive treatment than were others. Less is known, however, concerning the influence of sociomedical factors such as income and body composition on receipt of treatment. AIM: The aim of this study was to determine the importance of socioeconomic status, comorbidities, and body composition on receipt of treatment for ED symptoms. METHODS: We used data on 638 men enrolled in the Boston Area Community Health (BACH) survey reporting ED symptoms and/or treatment for ED as evidenced by phosphodiesterase type 5 inhibitor (PDE5i) use. Logistic regression was employed to assess the relative strength of association between receipt of treatment and socioeconomic factors, body mass index, and medical factors. A replication of these results was then provided via a parallel model using the 2004 follow-up of the Men's Attitudes to Life Events and Sexuality (MALES). MAIN OUTCOME MEASURE: In BACH, ED was deemed present if a subject scored 16 points or fewer on the five-item International Index of Erectile Function or reported PDE5i use. In MALES, presence of ED was indicated by use of a validated single question querying ED severity. RESULTS: Controlling for age, body composition and other factors, increased household income, availability of a sexual partner, and provider diagnosis of high blood pressure were positively associated with treatment seeking via the use of PDE5i therapy in BACH. Results on data available in MALES produced similar results for household income and partner availability. CONCLUSION: These data provide evidence that financial disadvantage may present a barrier to treatment of ED, an increasingly important sentinel marker of the cardiovascular and overall health among aging men.

The natural progression and regression of erectile dysfunction: follow-up results from the MMAS and MALES studies.

INTRODUCTION: Using the Massachusetts Male Aging Study (MMAS) data from the years 1987-1995, we previously demonstrated high rates of both progression (33%) and regression (35%) of self-reported severity of erectile dysfunction (ED). These results have not been replicated using more recent data-relevant in light of the introduction of phosphodiesterase type 5 inhibitors (PDE5i) to treat ED-nor compared with those from other populations. AIM: To estimate age-specific progression and regression of ED severity among subjects with at least mild self-reported ED. METHODS: We used the two most recent data collection waves from the MMAS (baseline in 1995-1997 and follow-up in 2002-2004, approximately 7 years of follow-up) and data from the Men's Attitudes to Life Events and Sexuality (MALES) study (baseline in 2001 and follow-up in 2004, approximately 3 years of follow-up); 367 MMAS and 617 MALES subjects contributed data. MMAS participants were a population-based sample of men living in Boston, Massachusetts, United States. MALES subjects were obtained from a multinational convenience sample. MAIN OUTCOME MEASURES: ED was measured using the validated single-question self-report of ED severity ("none,""minimal,""moderate," or "complete"). ED progression was defined as worsening of ED over time, whereas regression was defined as a lessening of ED severity. Logistic regression analyses were adjusted for age, body mass index (MMAS only), and use of PDE5i. RESULTS: In MMAS and MALES, 21% (confidence interval [CI]: 17%, 25%) and 25% (22%, 29%) of subjects, respectively, exhibited regression; 51% (45%, 57%) in MMAS and 28% (23%, 33%) in MALES exhibited ED progression. A minority of subjects (14% in MMAS and 28% in MALES) reported use of PDE5i. The proportion of subjects reporting progression increased with age. The higher rate of progression in MMAS may be due in part to the shorter follow-up time (∼3 years) in MALES. CONCLUSIONS: Among subjects with some level of self-reported ED, progression and regression are common over a several-year period. Strategies for therapy and intervention for ED should acknowledge this basic evolution with time.

Sexual satisfaction and relationship happiness in midlife and older couples in five countries.

Sexuality research focuses almost exclusively on individuals rather than couples, though ongoing relationships are very important for most people and cultures. The present study was the first to examine sexual and relationship parameters of middle-aged and older couples in committed relationships of 1-51 years duration. Survey research was conducted in Brazil, Germany, Japan, Spain, and the U.S. targeting 200 men aged 40-70 and their female partners in each country, with 1,009 couples in the final sample. Key demographic, health, physical intimacy, sexual behavior, sexual function, and sexual history variables were used to model relationship happiness and sexual satisfaction. The median ages were 55 for men and 52 for women; median relationship duration was 25 years. Relationship satisfaction in men depended on health, physical intimacy, and sexual functioning, while in women only sexual functioning predicted relationship satisfaction. Models predicting sexual satisfaction included significant physical intimacy and sexual functioning for both genders and, for men, more frequent recent sexual activity and fewer lifetime partners. Longer relationship duration predicted greater relationship happiness and sexual satisfaction for men. However, women in relationships of 20 to 40 years were significantly less likely than men to report relationship happiness. Compared to men, women showed lower sexual satisfaction early in the relationship and greater sexual satisfaction later. Within the long-term committed relationship context, there were significant gender differences in correlates of sexual and relationship satisfaction, with sexual functioning a common predictor of both types of satisfaction and physical intimacy a more consistent and salient predictor for men.

Erectile dysfunction and constructs of masculinity and quality of life in the multinational Men's Attitudes to Life Events and Sexuality (MALES) study.

INTRODUCTION: The Men's Attitudes to Life Events and Sexuality (MALES) study assessed the prevalence and correlates of erectile dysfunction, and examined men's attitudes and behavior in relation to this dysfunction. AIM: To report on the attitudes of men, with and without self-reported erectile dysfunction, concerning masculine identity and quality of life. METHODS: The MALES Phase I study included 27,839 randomly selected men (aged 20-75 years) from eight countries (United States, United Kingdom, Germany, France, Italy, Spain, Mexico, and Brazil) who responded to a standardized computer-assisted telephone interview. MAIN OUTCOME MEASURE: Perceptions of masculinity and quality of life in men with and without erectile dysfunction. RESULTS: Men's perceptions of masculinity differed substantially from stereotypes in the literature. Men reported that being seen as honorable, self-reliant, and respected by friends were important determinants of self-perceived masculinity. In contrast, factors stereotypically associated with masculinity, such as being physically attractive, sexually active, and successful with women, were deemed to be less important to men's sense of masculinity. These findings appeared consistently across all nationalities and all age groups studied. For quality of life, factors that men deemed of significant importance included good health, harmonious family life, and a good relationship with their wife/partner. Such factors had significantly greater importance to quality of life than concerns such as having a good job, having a nice home, living life to the full, or having a satisfying sex life. Of note, rankings of constructs of masculinity and quality of life did not meaningfully differ in men with or without erectile dysfunction, and men with erectile dysfunction who did or did not seek treatment for their sexual dysfunction. CONCLUSIONS: The present findings highlight the significance of partnered relationships and interpersonal factors in the management of erectile dysfunction, and empirically challenge a number of widely held stereotypes concerning men, masculinity, sex, and quality of life.