BMJ  2003;327:426-427 (23 August), doi:10.1136/bmj.327.7412.426

Primary care

Sexual function problems and help seeking behaviour in Britain: national probability sample survey

¹ Centre for Infectious Disease Epidemiology, Department of Primary Care and Population Sciences and Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, London WC1E 6AU, ² HIV/STI Division, Communicable Disease Surveillance Centre, Health Protection Agency, London NW9 5EQ, ³ Centre for Sexual and Reproductive Health Research, School of Hygiene and Tropical Medicine, London WC1E 7HT, ⁴ National Centre for Social Research, London EC1V 0AX

Introduction

The need for estimates of the extent of sexual function problems in the general population has become more urgent given recent debates surrounding the identification and definition of "sexual dysfunction," the increased availability of pharmacological interventions, and possible changes in our expectations of what constitutes sexual function and fulfilment.¹ We report results from the national survey of sexual attitudes and lifestyles (Natsal 2000).

Participants, methods, and results

Natsal 2000 was a stratified probability sample survey done between May 1999 and February 2001 of 11 161 men and women aged 16-44 years resident in Britain.^{2 3} The response rate was 65.4%. A computer assisted self interview asked participants about their sexual lifestyles and attitudes. We asked questions about their experience of sexual problems based on those used in the US national health and social life survey,⁴ which measured the main dimensions of sexual dysfunction, as defined in ICD-10 (international classification of diseases, 10th revision). We analysed data in STATA accounting for the sample's stratification, clustering, and weighting.^{2 3}

A total of 34.8% of men and 53.8% of women who had at least one heterosexual partner in the previous year reported at least one sexual problem lasting at least one month during this period (table). The most common problems among men were lacking interest in sex, premature orgasm, and anxiety about performance; and among women, inability to experience orgasm and painful intercourse. Persistent sexual problems—lasting at least six months in the previous year—were less prevalent among men (6.2%) than among women (15.6%). The most common persistent problem among men was premature orgasm and among women, lack of interest in sex.

View this table: [in this window] [in a new window]   Self reported problems related to sexual function by people who had at least one heterosexual partner in the previous year. Values are prevalences (95% confidence interval)

 

Among people who had sexual problems, 32.5% (95% confidence interval 29.7% to 35.3%) of men and 62.4% (60.4% to 64.3%) of women avoided sex because of their problems. Only 10.5% (8.8% to 12.4%) of men and 21.0% of women (19.3% to 22.7%) with problems in the previous year sought help. People with persistent problems were more likely to have sought help (20.5% (15.8% to 26.3%) of men and 31.9% (28.4% to 35.5%) of women). Among people seeking help, 63.8% (54.6% to 72.1%) of men and 74.3% (70.1% to 78.1%) of women consulted their general practitioner, and 9.2% (5.3% to 15.4%) of men and 4.8% (3.2% to 7.2%) of women sought help at a genitourinary clinic.

Comment

Problems of sexual function are relatively common, but persistent problems are much less so. Inconsistent definitions make comparing prevalences with other studies difficult. Given the broad spectrum of problems, we have not sought to define clinical "dysfunction" but rather to describe the range of problems of sexual function in the population and to use duration of problems and avoidance of sex as indicators of severity. We asked specifically about problems that lasted more than one month in the previous year; but whether, for example, lacking interest in sex can be considered as "dysfunction" is questionable since it was reported by two fifths of women and one fifth of men.

Few people sought help with their problems reflecting how severity varies, and how the need for professional intervention depends on the perceived importance to the patient and the underlying causes. Seeking help also reflects awareness of the availability of advice and treatment; more men present with sexual problems at genitourinary clinics since the licensing of sildenafil.⁵ People who often seek help consult their general practitioner but given the limited time and resources in this setting, such problems may be accorded low priority.

Our data have implications for improving relationship education, counselling, medical education, and doctors' professional development; raising public awareness of the range and location of services available for managing sexual problems; and re-examining the nature of "sexual dysfunction" and how best to tackle it.

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Editorial by Ogden See also p 423

Contributors: CHM was the lead writer of this paper and did all statistical analyses. KAF, AMJ, KW, and BE were coinvestigators and designed, implemented, and managed the study and prepared the manuscript. SMcM, KN, and WM also prepared the manuscript. CHM is guarantor.

Funding: Medical Research Council, Department of Health, Scottish Executive, and National Assembly for Wales.

Competing interests: None declared.

References

1. Moynihan R. The making of a disease: female sexual dysfunction. BMJ 2003;326: 45-7.[Free Full Text]
2. Johnson AM, Mercer CH, Erens B, Copas AJ, McManus S, Wellings K, et al. Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours. Lancet 2001;358: 1835-42.[CrossRef][Web of Science][Medline]
3. Erens B, McManus S, Field J, Korovessis C, Johnson AM, Fenton K, et al. National survey of sexual attitudes and lifestyles II: technical report. London: National Centre for Social Research, 2001.
4. Laumann EO, Gagnon JH, Michael RT, Michaels S. The social organisation of sexuality: sexual practices in the United States. Chicago: University of Chicago Press, 1994.
5. Kell P. The provision of sexual dysfunction services by genitourinary medicine physicians in the UK, 1999. Int J STD AIDS 2001;12: 395-7.[Abstract/Free Full Text]

(Accepted July 7, 2003)

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