Epidemiology Of Sexual Dysfunction

Numerous population surveys in this and other countries indicate a high prevalence of sexual problems in the general population. These surveys indicate that ^40% of women have evidence of psychosexual dysfunction. The corresponding number for men is ~30% (25). We have more evidence concerning the prevalence of sexual problems in men than women although the data base in both groups is rapidly growing. Correlates of erectile dysfunction in men include diabetes, vascular disease, age, and cigarette smoking. Serum dehydroepiandro-sterone and high-density lipoprotein cholesterol were found to be negatively correlated with erectile problems (26). Depression was correlated with erectile function in cross sectional studies, whereas passive personality traits tended to predict who would develop impotence in a prospective study (27). Studies in other countries have, in general, found somewhat similar rates of erectile dysfunction in the same age population and also that erectile dysfunction tends to correlate with the presence of diabetes, higher age, cardiovascular disease, and depression (15,28-32).

It is important to note that depression is not the only mental disorder associated with sexual dysfunction(s). Sexual dysfunction occurs in course of schizophrenia (33,34) or anxiety disorders (35).

Some recent studies went beyond collecting pure epidemiological data and studied the impact of sexual dysfunction on men suffering from various sexual dysfunctions. For instance, Moore et al. (36) described that younger men suffering from erectile dysfunction reported comparatively less relationship satisfaction, greater depressive symptomatology, more negative reactions from partners, and less job satisfaction than older men. They concluded that older men experience less difficulty than younger men adjusting to life with erectile dysfunction. Symonds et al. (37) interviewed men with self-diagnosed premature ejaculation. In their relatively small sample, they found that men with premature ejaculation had a sense that premature ejaculation was causing (not exclusively)

lower self-esteem and had impact on forming a relationship. Findings of these two studies underscore the complexity of sexual dysfunctions/disorders and their connection to an overall functioning and well-being.

A population study of US females aged 18-65 (25) found that -33% of US females reported low libido, trouble with orgasm, or difficulty with lubrication for at least 1 month in the previous year. Other surveys have reported similar findings. Hawton (38) studied sexual activity in a community sample in Oxford, United Kingdom and found that 17% reported never experiencing an orgasm and only 29% reported experiencing orgasm at least 50% of the time. Marital satisfaction was the major predictor of sexual activity and satisfaction. Dunn (39,40) also reported several population studies in the United Kingdom. Approximately 40% of the women reported a sexual problem, the most common being difficulty reaching orgasm. A recent population survey in Sweden (41) of sexual behavior in women aged 18-74 found that the most common problems were low desire followed by orgasm and arousal difficulties. They also reported considerable co-morbidity between sexual disorders. Some (42) questioned the methodology of epidemiological studies of sexual dysfunction as too simplistic and medicalized.

Laumann et al. (43) have recently completed a survey of 27,500 men and women aged 40-80 in 29 countries. In Northern European countries, lack of sexual interest was reported in 25.3% of women. Problems with orgasm and pain were reported in 16.9% and 17.7%, respectively. In men, low libido was reported in 12%, erectile dysfunction in 12%, and rapid ejaculation in 20.6%. Similar values were reported for other world regions, with minor differences in prevalence among different regions.

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