Epidemiology

The best information on the epidemiology of sexual disinterest in men comes from surveys of the general population and convenience samples. In the literature on this subject, little attempt is made to distinguish between the different diagnostic subtypes described in the "Classification" section of this chapter.

An excellent source of population-based information on sexual disinterest in men comes from the National Health and Social Life Survey (NHSLS; 15).

Laumann and his colleagues interviewed a probability sample of 3432 adults (including 1410 men) in the US between the ages of 18 and 59. Because the study is so often cited, it is worth examining the results in some detail.

In a 90 min interview on many sex-related subjects, one of the questions asked was "during the last 12 months has there ever been a period of several months or more when you lacked interest in having sex?" (No apparent attempt was made to subtype the responses.) Overall, 16% of the men said they were indeed not interested in sex (vs. 33% of the women). When the responses were assembled into 5-year groupings, the highest numbers of those who answered "yes" were from men who were in two groups: those who were 40-44 and 50-59 years old. These numbers do not quite fit with the common perception of waning sexual desire with increasing age. The figures seem to suggest a greater degree of complexity. Contrary to expectations, the fewest men who answered "yes" were in the group of men who were 44-49 years. Looking at the opposite end of the sexually active age spectrum, and again not quite fitting with common beliefs, 14% of the youngest group of men (18-24 years old) also answered positively.

Some social factors examined in the Laumann et al. study correlated with lack of sexual desire in men (15). Those who answered affirmatively included 20% of the "never married" men (vs. 12% of the married); 22% of the men whose education was "less than high school" (vs. most of the other levels of education where the range was 13-16%); and 20% of black men (vs. 15% of whites). The impact of religion was unclear with no one religious group outstanding. The relationship to poverty was striking in that 25% of poor men responded positively (vs. 13 -15% of men at other income levels).

In the same survey, health and happiness were also separately correlated with sexual disinterest. The greater the impairment of health and the magnitude of unhappiness, the greater the extent of sexual disinterest.

Further analysis of the sexual dysfunction data from the NHSLS survey used multivariate techniques to estimate the relative risk (RR) for each demographic characteristic as well as for key risk factors (16). In comparing the oldest group of men (50-59) to the youngest (18-29), the former were three times as likely to experience low sexual desire. Similarly, "never married" men were almost three times as likely to experience lack of sexual desire compared to those who were "currently married."

The statistical method of latent class analysis (LCA) was also used for "analyzing risk factors and quality-of-life concomitants in relation to categories of sexual dysfunction rather than individual symptoms." Risk factors that were found to be predictors of low sexual desire in men included "daily alcohol consumption," "poor to fair health," and "emotional problems or stress." The same was true of "thinking about sex less than once weekly" (more than three times as likely vs. those who thought about sex more than once weekly), ever had any "same-sex activity" (more than twice as likely vs. those that never did), and "sexually touched before puberty" (about twice as likely vs. those that were not touched).

When considering quality-of-life concomitants, men with low sexual desire experienced a low level of physical satisfaction and a low level of general happiness, with their "primary" partner.

Another survey using a stratified probability sample was conducted in Britain and concerned the prevalence of sexual function problems in people who had at least one heterosexual partner in the past year. The study took place from 1999 to 2000 and involved 11,461 men and women aged 16-44 (17). The response rate was 65.4%. Problems were reported according to two duration periods: those which lasted at least 1 month in the past year, and those which lasted at least six months in the past year. Thirty-five percent of men reported at least one sexual problem in the past year, and "lack of interest in sex" was the most common such concern (17%) in the shorter time period. The prevalence dropped to 2% when considering the "at least 6-months" time frame.

In yet another study involving 100 "normal" volunteer couples who were well-educated and who regarded their marriages as ones that were "working," Frank et al. (18) found that a similar (to the US and UK studies) percentage of men (16%) were sexually disinterested.

Similarly, when a sample of gay men were asked about sexual concerns, including "lack of interest in or desire for sex," 16% said it was a current problem and 49% indicated that it was a problem at some time in their lives

(19). Two other studies that bear on the subject of epidemiology are described elsewhere in this chapter: (a) the section on "Classification—Subtyping of HSDD Syndromes" includes the finding by Kinsey et al. (13) of a small group of men with the lifelong and generalized form of HSDD, and (b) the section on "Etiology—Presence of Another Sexual or Gender Disorder in a Patient or Partner" includes results of an investigation conducted by Segraves and Segraves

(20) who reported on men and women with HSDD in a population that was recruited for a study of sexual disorders generally.

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