Introduction

The runaway success of Viagra and other new pharmaceutical treatments for sexual dysfunction in men, and drug companies’ eager quest to devise equivalent medications for women, have brought unprecedented public attention to sexuality in mid- and later life. Popular media accounts often ask whether these medical “fixes” truly deliver on their promise to enhance individuals’ and couples’ sexual satisfaction and whether heterosexual women always appreciate the drugs’ effects on their partners (Croissant, 2006; Loe, 2004; Vares & Braun, 2006). In turn, these treatment-specific questions raise more general concerns about the relationships among age, gender, and sexual satisfaction, and about the relative importance of biological, social, cultural, and psychological factors in explaining variations in sexual life.

Until recently, scholars in sexuality and gender studies had all but neglected the sexual lives of middle-aged and older women and men, focusing instead on adolescents or adults of “childbearing” age. Conversely, experts on aging rarely asked questions about sex (Calasanti & Slevin, 2001). Much of the literature on aging and sexuality is narrowly concerned with factors, especially physiological factors, that affect sexual “function”—the ability to perform sexually—and with the more quantifiable aspects of sexuality, such as frequency of sexual activity. Yet, the importance of understanding the subjective dimensions of sexuality, like physical and emotional satisfaction, and the ways they are patterned by aging and gender, cannot be underestimated. What, for instance, can one make of the observation that men and women have sex less often as they get older without knowing whether this change brings them frustration or relief?

Better understanding of the dynamics of sexual satisfaction is particularly crucial. Sexual satisfaction has been shown to enhance individuals’ well-being as well as the stability of marriages and other intimate relationships (Henderson-King & Veroff, 1994; Sprecher, 2002). Expanded knowledge of the factors that enhance and diminish sexual satisfaction can pave the way for more effective clinical and policy responses to sexual problems (Bancroft, 2002). More generally, understanding sexuality in later life is becoming increasingly imperative as the U.S. population ages, as individuals live longer, healthier lives, and as beliefs about the nature of aging and gender and the importance of sexuality for personal happiness are transformed (Calasanti & Slevin, 2001; Seidman, 1991).

This article addresses critical gaps in the literature by exploring social, cultural, and physiological factors that contribute to age and gender differences in sexual satisfaction among sexually-active, middle-aged, heterosexual adults in the United States. Recent studies have indicated that sexual satisfaction begins to decline in late middle age, especially among women (AARP, 1999; Edwards & Booth, 1994; Laumann, Gagnon, Michael, & Michaels, 1994). Yet, researchers have yet to establish fully the social dynamics responsible for these patterns. Many studies treat gender cursorily and few adequately distinguish between the effects of aging and generation. Our analysis of data from the 1992 National Health and Social Life Survey (NHSLS) examined how women’s and men’s satisfaction with their sexual relationships was influenced—possibly differentially—by aging, physical health, sexual functioning, partners’ health and functioning, relationship factors, sexual practices and attitudes, and birth cohort.

Age, Gender, and Sexual Satisfaction

Measuring Sexual Satisfaction

Researchers have conceptualized sexual satisfaction and problems/dissatisfaction in diverse ways. Early studies often used the frequency of sexual intercourse or orgasms as proxies for sexual satisfaction (Henderson-King & Veroff, 1994). Recently, scholars have measured satisfaction more directly (e.g., through self reports). They have also begun to address affective as well as physical dimensions of satisfaction and to include relationship factors and (less often) cultural context alongside physiology and personality as possible determinants of sexual satisfaction (Christopher & Sprecher, 2000; Marsiglio & Greer, 1994). Scholars disagree as to whether the physical and emotional dimensions of sexual satisfaction merit separate analyses. Many studies employ composite measures (e.g., Liu, 2003; for a critique, see Christopher & Sprecher, 2000); however, some analyses find that the predictors of physical and emotional satisfaction differ (e.g., Waite & Joyner, 2001). Researchers also disagree about the relative utility of objective versus subjective measures. As Bancroft, Loftus, and Long (2003) demonstrated, objective measures of sexual problems (e.g., lubrication difficulty, painful intercourse) are not always accompanied by subjective reports of distress or dissatisfaction, and vice versa. This article focuses on middle-aged adults’ subjective (i.e., self-reported) satisfaction with the emotional and physical dimensions of their primary sexual relationships.

Our conceptual framework posits gendered patterns of sexual satisfaction in midlife to be shaped by the interaction of factors at the levels of the individual, the relationship, and the broader culture (cf. Bancroft et al., 2003; Marsiglio & Greer, 1994). Key individual-level factors include personal sexual history and attitudes, as well as physical condition, including normal bodily aging, health status, and medical treatments. At the relationship level, the type, quality, and duration of the relationship, partner’s health and availability, and patterns of sexual activity are central. The cultural level encompasses widely shared beliefs and expectations about sexuality. The dynamics of sexual satisfaction are influenced at all three levels by age, gender, and cohort/generation.

On balance, research indicates that older adults are less sexually satisfied than their younger counterparts and that women are less satisfied than men. Methodologically diverse studies have found lower levels of sexual satisfaction among older participants (Brecher, 1983; Edwards & Booth, 1994; Haavio-Mannila & Kontula, 1997; Laumann et al., 1994). However, the majority of middle-aged and older adults describe sex as feeling as good or better than when they were younger (Starr & Weiner, 1981) and men’s sexual satisfaction levels appear to change little with age (McKinlay & Feldman, 1994; Schiavi, 1996). Several large-scale studies have observed men to be more sexually satisfied than women (Brecher, 1983; Laumann et al., 1994; Starr & Weiner, 1981; Waite & Joyner, 2001; but see AARP, 1999). Studies assessing the intersection of age and gender generally observe a more pronounced decline in sexual satisfaction among women, starting in late midlife (roughly ages 50–60 or 65) or early old age (roughly ages 60 or 65–75) (Brecher, 1983; Edwards & Booth, 1994; Laumann et al., 1994); some even show increased enjoyment of sex among aging men (Wiley & Bortz, 1996). The American Association of Retired Persons (AARP) (1999) survey is an exception, finding that, although sexual satisfaction declined with age for both genders, within age groups, men were more dissatisfied than women.

Individual Influences on Satisfaction

Physical changes associated with normal aging may reduce sexual desire, physiological sexual response, and therefore satisfaction with the physical aspects of sex (Schiavi, 1994; Segraves & Segraves, 1995). These effects differ by gender. For men, the major changes are difficulties getting and sustaining erections and ejaculating, due to decreasing testosterone, muscle tone, and blood circulation with age (Marsiglio & Greer, 1994; McKinlay & Feldman, 1994). For women, the major physiological changes include decreased vaginal lubrication and more painful intercourse (Huyck, 1994). However, sexual distress among women may be more closely associated with a lack of arousal or genital tingling than with difficulty lubricating (Bancroft et al., 2003). Women often experience physiological changes at menopause; yet, scholars disagree as to how adversely menopause affects women’s sexuality. A longitudinal study of middle-aged Australian women found that, while sexual arousal, orgasm, and enjoyment declined for all women, regardless of menopause status, menopause was specifically linked to increased pain during intercourse and decreased sexual desire, frequency, and positive feelings for one’s partner (Dennerstein, Dudley, & Burger, 2001). Yet, other studies indicate that many women experience few adverse changes in arousal and orgasm at menopause (Deeks & McCabe, 2001), and many find their sex lives enhanced by freedom from possible pregnancy (Barbre, 1998). Physical and mental health, smoking, and male partners’ sensitivity to menopausal symptoms may have a greater impact on women’s sexual functioning than menopause per se (Avis, Stellato, Crawford, Johannes, & Longcope, 2000; Winterich, 2003).

Aging-related illnesses, such as high blood pressure and diabetes, and their treatments may also reduce sexual desire and physiological response, and thus sexual satisfaction (Schiavi, 1994; Segraves & Segraves, 1995). Poor mental health is associated with diminished sexual satisfaction (Bancroft et al., 2003); ironically, however, many antidepressants reduce sexual desire or change people’s sexual lives in other dissatisfying ways. Physiological factors may also affect emotional satisfaction. Insofar as U.S. culture posits erections as virtually indispensable to masculine sexuality, anxiety about erectile dysfunction may affect older men’s enjoyment of sex, even prompting some to avoid sexual encounters altogether (Loe, 2001; Wiley & Bortz, 1996).

Sexual attitudes represent another individual-level predictor of sexual satisfaction—one that is patterned by gender and generation (Laumann et al., 1994). People with permissive beliefs (e.g., approving of casual sex) report higher levels of satisfaction than their less-permissive counterparts (Haavio-Mannila & Kontula, 1997). Our analysis departed from previous studies by treating sexual attitudes not merely as the property of individuals, but as reflections of the degree to which particular women and men subscribe to mainstream sexual culture (see below).

Most studies find little or no relationship between sexual satisfaction and race, ethnicity, socioeconomic status, and/or religion (Christopher & Sprecher, 2000). One exception found more pleasure among Blacks than Whites and less satisfaction among women with higher income (Henderson-King & Veroff, 1994). Some studies have observed fewer sexual problems among the college educated, possibly reflecting an educational difference in choosing scale options (Bancroft et al., 2003; Laumann et al., 1994).

Relational Influences on Satisfaction

Relationship-level factors also contribute to age and gender differences in sexual satisfaction. Overall, married people are more sexually satisfied than cohabiters and singles (Laumann et al., 1994), while committed daters are more satisfied than the sexually-active unattached (Pedersen & Blekesaune, 2003). Relationship type seems to affect emotional satisfaction more strongly than physical pleasure (Waite & Joyner, 2001), consistent with the commonsense assumption that people invest greater emotion in more committed relationships. Relationship quality appears to be reciprocally related to sexual satisfaction, with each enhancing the other (Christopher & Sprecher, 2000; Henderson-King & Veroff, 1994; Sprecher, 2002). Monogamous relationships are more conducive to sexual pleasure than non-monogamous ones, perhaps because monogamy facilitates learning one’s partner’s sexual preferences; however, it could be that dissatisfied partners seek sex outside the relationship (Laumann et al., 1994).

Sexual satisfaction tends to decline as relationships (of all types) endure over time, likely because familiarity makes sex routine or even boring (Edwards & Booth, 1994; Laumann et al., 1994; Pedersen & Blekesaune, 2003; Sprecher, 2002). The effects of duration account, in part, for the lower levels of satisfaction observed with increasing age. Using data from NHSLS, Liu (2003) found that longer relationships predicted lower sexual satisfaction among married 18–59-year-olds, but age did not (Liu did not, however, distinguish between age and cohort).

Cultural stereotypes suggest that women’s enjoyment of sex depends more on relational factors than does men’s, but empirical evidence is mixed. The duration of heterosexual college students’ relationships was better predicted by relationship satisfaction for women and by sexual satisfaction for men (Sprecher, 2002) and sexual satisfaction was more closely linked to the expectation of a lifelong relationship among women than men (Waite & Joyner, 2001). Yet, other studies have found that middle-aged and older men rated having a romantic relationship and a sensitive partner as more important to sexual satisfaction than did women (AARP, 1999) and that reciprocal love was a significant predictor of sexual satisfaction for men but not women (Haavio-Mannila & Kontula, 1997).

Sexual satisfaction also depends on one’s partner’s health and availability. Vaginal intercourse with a male partner who has difficulty sustaining an erection or ejaculating, or who ejaculates prematurely, or with a female partner who has trouble lubricating, may be physically uncomfortable and/or emotionally frustrating (Bancroft et al., 2003). Male partners’ ill health or sexual dysfunction, and/or their insensitivity to menopausal women’s lubrication difficulties, may also inhibit pleasure (Avis, 2000; Winterich, 2003). Having a partner who is unavailable for sexual activity—as when couples work different shifts—may also be dissatisfying (Keith & White, 1990). However, co-residing with children under 18 (which is correlated with relationship satisfaction and sexual frequency) does not appear to affect sexual satisfaction (Liu, 2003).

What couples do sexually represents another relational component of sexual satisfaction. Orgasm, the archetypal measure of physical pleasure, has been linked to higher levels of sexual satisfaction for both genders (Haavio-Mannila & Kontula, 1997; Waite & Joyner, 2001). Women climax less regularly than men (Laumann et al., 1994); however, orgasms appear to be more important for men’s sexual satisfaction (Bancroft et al., 2003; Nicolson & Burr, 2003; Starr & Weiner, 1981). People who engage in sexual activity relatively frequently report higher levels of sexual satisfaction than those who have sex less often (Haavio-Mannila & Kontula, 1997; Laumann et al., 1994; Waite & Joyner, 2001); this may hold especially true among women (Pedersen & Blekesaune, 2003). It is not clear whether satisfying sex inspires more frequent encounters or frequent sex improves technique; however, sexual satisfaction declines more slowly than frequency over time (Christopher & Sprecher, 2000). People who employ diverse sexual techniques in their encounters report greater satisfaction than the less adventuresome (Haavio-Mannila & Kontula, 1997), at least in part because many women require manual or oral clitoral stimulation, instead of, or in addition to, vaginal intercourse to achieve orgasm.

Cultural Influences on Satisfaction

Cultural norms equating sexual desirability and expression with youth may make middle-aged and older people feel ashamed of their sexual desires, in turn inhibiting their enjoyment of sex (Levy, 1994), or may prompt them to accept as inevitable reductions in sexual satisfaction that result from factors other than normal aging (Schiavi, 1996). People who reject this “aging as decline” model for a newer perspective emphasizing “healthy aging” may, conversely, harbor unrealistic expectations about sexuality in mid- and later life, and may feel dissatisfied if their sexual lives are adversely affected by normal aging or illnesses (Schiavi, 1996). Women may feel the impact of ageist cultural beliefs about sexuality with particular force, given the greater cultural emphasis on appearance and youth for female desirability (Gibson, 1993). Men who endorse prevailing cultural beliefs about masculine sexuality, which emphasize strength, competence, and assertiveness (not to mention erection capacity), may have trouble enjoying sex when their bodies start changing with age (Loe, 2001; Marsiglio & Greer, 1994). Yet, some adults reject these mainstream beliefs, responding to aging-related bodily changes in ways that help maintain sexual satisfaction, whether by adopting new sexual practices (e.g., emphasizing caressing rather than coitus) or revising their expectations (e.g., accepting less frequent orgasms) (Levy, 1994; Loe, 2001; Schiavi, 1996; Wiley & Bortz, 1996). Those who subscribe to the widespread belief that “real” sex entails penile-vaginal penetration and ejaculation may resist changing their practices and enjoy sex less (e.g., Winterich, 2003).

Cultural beliefs about sexuality, aging, and gender vary by generation (or cohort) (Riley, 1987). Social forces in the late 1960s and early 1970s, including the youth counterculture, effective contraceptives, Baby Boom, and rising divorce rates, helped to bring about a general liberalization of sexual mores and conduct, especially among people who were relatively young at the time (D’Emilio & Freedman, 1988). Longitudinal studies show that members of younger cohorts engage in more frequent sexual activity than members of older cohorts at the same ages (George & Weiler, 1981), although individual variations in sexual desire and conduct endure across the life course. Sexual satisfaction may be similarly patterned. Baby Boomers express greater approval of non-coital practices, such as oral sex, than do their parents, which may make them better prepared to adapt to aging-related physiological changes (Gagnon & Simon, 1987).

Cohort differences are especially pronounced among women, not least because second-wave feminism prompted many women to reject the sexual double standard (Luria & Meade, 1984). One recent survey found that objective sexual “problems” (e.g., difficulty lubricating) were more common in older women, but more distressing to younger women—likely a cohort effect (Bancroft et al., 2003). Feminism and the youth counterculture also worked to replace the view of “real” men as “sexual animals” to “competent lovers,” possibly heightening performance anxiety for some men (especially Baby Boomers) (Marsiglio & Greer, 1994). The advent of medications like Viagra is also liable to have differential effects across generation (Loe, 2001).

In sum, although research on sexual satisfaction is burgeoning, much remains to be understood (Christopher & Sprecher, 2000; Levy, 1994). Since most studies focus on young adults, examining sexual satisfaction among middle-aged and older people will help to reveal whether similar factors influence satisfaction at every stage of the life course. Better distinguishing between the effects of aging and cohort will help to enhance our understanding of the ways aging and cultural change impact sexual life. Closer examination of women’s and men’s subjective experiences can shed new light on heretofore mixed findings about gender and sexual satisfaction. More also remains to be known about the extent to which the physical and emotional dimensions of sexual satisfaction diverge from one another. Finally, key methodological issues must be addressed. Samples that include only currently-married people are common (e.g., Liu, 2003), many studies exclude one gender or the other, and some fail to distinguish consistently between people with and without partners (e.g., Wiley & Bortz, 1996).

Hypotheses

Based on our review of the literature and our understanding of the dynamics of physical and emotional satisfaction, we developed seven hypotheses about gender, aging, and sexual satisfaction. At the individual level (holding age, race/ethnicity, and socioeconomic status constant):

(H1)

People who were in poor health will report lower levels of pleasure, especially physical pleasure (H1a), than people who were in good health.

(H2)

People who experienced sexual “problems” will report lower levels of pleasure, especially physical pleasure (H2a), than people who were “problem-free.”

At the relationship level:

(H3)

People who were married or cohabiting, in a relatively long-term relationship, and who knew their partner relatively well before having sex will report higher levels of satisfaction than people who were single, in relatively short-term relationships, and/or relatively unfamiliar with their partner before sex.

(H3a)

These relationship factors will have greater bearing on emotional than physical satisfaction. (Given the mixed evidence in the literature, we did not predict whether these effects will differ by gender).

(H4)

People whose partners were in poor health or who experienced sexual “problems” will report lower levels of pleasure, especially physical pleasure (H4a), than people with healthy, problem-free partners.

(H5)

People who had sex relatively frequently, achieved orgasm regularly, had relatively lengthy sexual encounters, and engaged in activities other than vaginal intercourse will report greater pleasure than people who had sex seldom, often did not orgasm, had brief encounters, and engaged only in vaginal sex.

(H5a)

Sexual practices will affect physical pleasure especially and (H5b) will have a stronger impact on men than on women.

At the cultural level:

(H6)

People with more traditional beliefs about sexual morality and gender differences in sexuality will report lower satisfaction than their less-traditional peers.

(H6a)

Sexual attitudes should have a more pronounced effect for women, given the greater impact of post-1960s liberalization on women’s sexuality.

(H7)

The effects of sexual attitudes and of age will be mediated by generation (Baby Boom versus WWII).

Method

Participants

Data for this study come from the NHSLS, a unique data set containing a wealth of detailed information about sexual conduct and attitudes (Laumann et al., 1994). Fielded in 1992, the NHSLS conducted in-person interviews with 3,432 English-speaking adults, aged 18–59 years, randomly drawn from a national sample of U.S. households, using an area probability design and oversampling for African Americans and Hispanics. People in the military and/or residing in institutions were excluded. The response rate was almost 80%. This is similar to response rates for major national surveys, such as the General Social Survey, and substantially higher than response rates for many published studies on sexuality, enhancing our confidence in the validity of our findings.

Of the NHSLS participants who self-identified as heterosexual, 1,240 were middle-aged, between 40 and 59, at the time of the survey. Our analysis focused on the 1,035 (83.4%) of these middle-aged participants who reported having a sexual partner in the previous year. They are broadly representative of the U.S. population in terms of gender, racial-ethnic background, education, household income, and religion (Table 1). We would have liked to include gay, lesbian, and bisexual participants in our analyses; yet, only 14 NHSLS participants aged 40–59 self-identified as anything other than heterosexual, precluding statistically meaningful analysis by sexual identity.

The subsample of the NHSLS that we analyzed included people born as early as 1933 and as late as 1952. Depending on their ages, these women and men were liable to have had disparate experiences of the events of the late 1960s and early 1970s, which arguably transformed the way Americans understood sexuality, gender, and aging (D’Emilio & Freedman, 1988). Following convention, we classified participants born between 1933 and 1945 as members of the Great Depression/World War II generation and those born from 1946 onward as Baby Boomers. The NHSLS must likewise be situated in historical context. It was conducted before the advent of Viagra and anti-retroviral therapies for HIV, and at a time when moral conservatives were gaining considerable influence over U.S. public policy.

Procedure and Measures

The major advantage of the NHSLS is the plethora of detailed information it included about almost every aspect of sexual behavior, beliefs, and fantasy. Crucial for our purposes, the questionnaire distinguished between the physical and emotional dimensions of sexual satisfaction. The NHSLS also employed an especially inclusive definition of “sexual activity,” encompassing any voluntary “direct physical contact with the genitals...of someone else” where “sexual excitement or arousal occurred...even if intercourse or orgasm did not occur.” This definition was well-suited for our research, since aging-related difficulties with erection and ejaculation may impair couples’ ability to engage in vaginal intercourse but not other kinds of sex (see Calasanti & Slevin, 2001; Levy, 1994). The chief drawback of the NHSLS was that data were cross-sectional. Without longitudinal data on participants, we could not fully distinguish between aging and cohort effects (though our models did include separate variables for age and cohort); nor could we fully disentangle cause from effect. For our aim of exploring sexual satisfaction in midlife, however, the advantages of the data set outweighed the drawbacks.

The dependent variables in our analyses were participants’ reports of physical pleasure and emotional satisfaction within their primary sexual relationship in the 12 months before the survey. We determined individuals’ satisfaction based their on responses to the questions: “How physically pleasurable did you find your relationship with (PARTNER) to be?” and “How emotionally satisfying did you find your relationship with (PARTNER) to be?” Response options included “extremely,” “very,” “moderately,” “slightly,” and “not at all pleasurable/ satisfying.” The two most-negative categories amounted to only 4% and 6% of reports of physical and emotional satisfaction, respectively, and few participants reported moderate satisfaction (13% and 15%, respectively). Our analyses therefore combined the latter three categories into one: “less pleasurable/satisfying.” This skewed pattern appears in other studies of sexual satisfaction, and may stem from people’s reluctance to admit that their relationship is less than satisfying (Bancroft et al., 2003; Sprecher, 2002). Physical pleasure and emotional satisfaction were closely correlated (0.71, similar for men and women) and no doubt interrelated. We opted to analyze the two dimensions of satisfaction separately not only because they are imperfectly correlated, but also because we expected that they might be influenced by different factors. Because the dependent variables were categorical rather than truly continuous, we used multinomial logistic regression for our primary analyses.

The independent variables included in our analyses are shown in Table 1. For the majority of variables (e.g., health status, sexual attitudes), we created categories based on bivariate patterns of sexual satisfaction. Our analyses distinguished between people who were currently cohabiting (94% of whom were married) and people who were not (who may be single, separated, or divorced). Although some studies of sexual satisfaction find cohabiters to resemble singles more than the married, we grouped married and cohabiting people together, both to reflect partner availability and because of bivariate patterns among the 40–59 age group. Participants were designated as having sexual “problems” if they experienced one or more of seven conditions in the year preceding the survey (Table 1, note b). This measure was not ideal, insofar as it disregarded whether a participant found a particular functional experience problematic or distressing (see Bancroft et al., 2003); however, it was the best measure available. Since NHSLS did not include direct measures of partners’ health or sexual problems, we used age as a proxy—comparing partners aged under 40, 40–59, and 60 and older—on the grounds that certain sexual difficulties, and many health conditions that impair sexual function, become more common with age. Regrettably, NHSLS did not ask participants to assess the quality of their relationships, nor did it include a measure of mental health that was sufficiently independent to permit inclusion in our models. We measured cultural factors broadly, through two attitudinal variables meant to capture sexual conservatism (beliefs about sex without love and sex before marriage), which has been linked to lower levels of satisfaction, and one intended to assess gender traditionalism (men’s and women’s relative sexual needs). Believing that men need sex more than women do may reflect adherence to traditional understandings of masculine sexuality (men as active penetrators) and feminine sexual worth (emphasizing youth and beauty), which may impede adjustment to aging-related sexual changes. NHSLS did not include any items measuring attitudes about sexuality and aging.

Table 1 Selected characteristics of sexually-active NHSLS participants, age 40–59 years

Results

To identify the social factors that affected sexually-active adults’ satisfaction in their primary relationships, we began with a bivariate analysis of the links among gender, age, and physical pleasure/emotional satisfaction. Women overall described their relationships as less satisfactory, physically and emotionally, than did men (Table 2). The level of physical pleasure men received from their sexual relationships varied little by age. Women, however, reported significantly lower levels of physical pleasure at older ages, especially after age 56. The proportion of women describing their relationships as extremely emotionally satisfying likewise decreased with age, while the opposite was true for men (the pattern was statistically significant for women only).

Table 2 Physical and emotional satisfaction with primary sexual partner, by gender and age

To better understand these patterns, we used multinomial logistic regression to predict the relative risk of a respondent finding his or her primary sexual relationship (1) extremely physically pleasurable or not-so-pleasurable, compared with very pleasurable, and (2) extremely emotionally satisfying or not-so-satisfying, compared with very satisfying. For both dimensions of satisfaction, we tested models including various combinations of six categories of independent variables, mapping to the individual, relationship, and cultural levels of sexual life: Individual level (1) age and, as controls, racial/ethnic background, household income, and educational attainment; (2) overall physical health, sexual “problems,” and (for women) menopause status; Relationship level (3) relationship factors (cohabitation status, duration of relationship since first sex, time partner known before first sex) and partner’s age; (4) bodily sexual practices (sexual frequency, regularity of orgasm, duration of most-recent encounter, engaging in oral sex); Cultural Level (5) attitudes about sex without love, premarital sex, and gender differences in sexuality; and (6) generation (Great Depression/WWII versus Baby Boom). We also tested for interactions among key variables (e.g., race and sexual attitudes), but none of the interaction terms predicted levels of sexual satisfaction for men or women. Based on our review of the literature and gender differences at the bivariate level, we initially fitted separate models for men and women. The significant predictors of sexual satisfaction proved sufficiently different by gender that we decided to retain these separate models.

Our final models for physical pleasure (Tables 3 and 4) included age and demographic characteristics; physical health and sexual problems; cohabitation status and relationship duration; three dimensions of sexual practice; attitudes about sex without love and gender differences in sexuality; and generation. Our final models for emotional satisfaction (Tables 5 and 6) contained the same variables as those for physical pleasure, with the addition of partner’s age and how long people knew their partners before having sex (neither of which significantly predicted physical satisfaction). Attitudes about premarital sex were not significant predictors of sexual satisfaction in any of the models we tested, for men or women, nor were menopause status, oral sex practices, or erectile or lubrication difficulties measured apart from other sexual problems; nor did adding these variables improve our models’ fit (data not shown).

Table 3 Predictors of women’s physical pleasure with primary sexual partnera
Table 4 Predictors of men’s physical pleasure with primary sexual partnera
Table 5 Predictors of women’s emotional satisfaction with primary sexual partnera
Table 6 Predictors of men’s emotional satisfaction with primary sexual partnera

Individual Level Factors

Our predictions about the effects of health status (H1) and sexual problems (H2), especially on physical pleasure (H1a and H2a), received partial support. Men in fair or poor health (H1) reported significantly lower levels of physical pleasure (H1a) than healthy men in our simplest model (Table 4, Model 1). This pattern appears to reflect the direct results of ill health and/or medical treatments, for having sexual problems in the past year (H2) also predicted lower levels of physical pleasure (H2a). These variables became statistically non-significant when sexual practices were added to the model (Model 3), however, suggesting that health and sexual problems affected men’s physical satisfaction chiefly through their influence on sexual frequency, duration, and orgasm. Health status did not predict physical pleasure for women (contra H1a), but healthy women were more likely than unhealthy women to report both extremely emotionally satisfying and not-so-emotionally satisfying relationships (Table 5, Models 3–5). Women who experienced sexual problems (H2) were over twice as likely to describe their relationships as physically and emotionally not-so-pleasurable than problem-free women (Tables 3 and 5, Models 2–5). (As noted, menopause status did not significantly predict either dimension of satisfaction). Our findings for men supported our hypotheses (H1a and H2a) that health and sexual problems would primarily affect physical pleasure; however, these factors (especially health) had a greater impact on women’s emotional than physical satisfaction.

Although age is an individual attribute, our hypotheses focused on the relationship of age to generation; we therefore discuss age alongside cultural-level factors (below). We did not develop hypotheses about the effects of race/ethnicity, education, and income, expecting that they would not affect satisfaction once other factors were accounted for. By and large, we were correct. However, women of color were about twice as likely as white women to express dissatisfaction with the physical aspects of their sexual relationships (Table 3, Models 1–5). Men who completed at least some college were significantly less likely to report extremely emotionally satisfying relationships than men with high school degrees (Table 6, Models 2–5).

Relationship Level Factors

Our hypotheses about relationship-related variables (H3) received support in two cases. First, men who were not cohabiting/married reported significantly lower levels of physical pleasure than cohabiting/married men (Table 4, Models 3–4), though this effect became non-significant when attitudes about sex without love were added to the model. Second, women who knew their partners more than a year before having sex were significantly less likely to report not-so-emotionally satisfying relationships than women who had known their partners more briefly (Table 5, Models 2–5). The latter finding supported our prediction that relationship factors would have greater bearing on emotional than physical satisfaction (H3a), while the former suggested the converse. Relationship duration was not a significant predictor of physical or emotional satisfaction in any of the models we tested, for men or women, although adding the variable improved the models’ fit (all Tables, Models 2–5).

Our prediction of less pleasure among people whose partners were in poor health or who experienced sexual problems (H4) was supported only for women, and only in the case of emotional satisfaction (contra H4a). Women with partners aged 60 or older were significantly less likely than women with younger partners to describe their relationships as extremely emotionally satisfying, controlling for relationship factors and sexual practices (Table 5, Models 2–5). This effect became non-significant when generation was taken into account (Model 5).

We found considerable support for our hypothesis (H5) linking bodily aspects of sexual conduct to greater sexual satisfaction; yet, bodily practices seemed just as important for emotional as physical pleasure (contra H5a) and appeared to be more central to women’s pleasure than to men’s (contra H5b). Women rated their sexual relationships more physically and emotionally pleasurable if their most-recent sexual encounter lasted a comparatively long time; less physically pleasurable if they had orgasms only sometimes (versus always); and less physically and emotionally pleasurable if they had sex relatively infrequently (Tables 3 and 5, Models 3–5). Men whose most-recent sexual encounters lasted 16–29 min reported more physical pleasure than men whose encounters were shorter and men who had sex relatively rarely reported less emotional satisfaction than men who had sex more often (Tables 4 and 6, Models 3–4).

Cultural Level Factors

We found some support for our hypothesis (H6) that levels of sexual satisfaction would be partly explained by agreement with the dominant sexual culture. As predicted, women who believed that men have greater sexual needs than women were less likely to report extremely physically satisfying relationships than their less-traditional counterparts (Table 3, Models 4–5). This relationship remained significant when generation was included in the model, indicating the influence of variations in belief among members of the same generation (rather than a simple generation gap). Attitudes about gender and sexuality were not associated with women’s emotional pleasure or with either dimension of satisfaction for men. These findings were consistent with our prediction (H6a) that attitude effects would be more pronounced among women, given the greater impact of late-1960s social changes on women. Beliefs about premarital sex did not predict levels of sexual satisfaction in any of the models we tested.

Men who disapproved of sex without love were significantly more likely to rate their relationships as extremely physically and emotionally satisfying than men who approved (Tables 4 and 6, Models 4–5), and women who disapproved of sex without love reported higher levels of emotional satisfaction (Tables 3 and 5, Models 4–5). We had, however, predicted (H6) that sexual conservatism would be associated with lower levels of satisfaction. Beliefs about sex without love can be interpreted as indicating not only agreement with dominant cultural mores, but also the quality of a person’s relationship with her/his sexual partner—at least to the extent that people who disapprove of loveless sex tend to be in love with their partners. (We discuss the implications of this alternative interpretation below). This latter finding suggested a closer link between beliefs and satisfaction for men than women (contra H6a); although our finding about beliefs about gender differences in sexual needs suggested the converse (supporting H6a).

Our hypothesis that generation would mediate the effects of sexual attitudes (H7) was not supported. Generation was not a significant predictor of physical or emotional satisfaction, for men or women, in any of the models we tested. Nor did adding generation to the models alter the significance of attitudes variables for women or men. However, generation did appear to mediate the effects of age (H7). Age was not associated with men’s physical or emotional satisfaction, except that older men were more likely to be extremely emotionally satisfied (Table 6, Model 4). In contrast, with each additional year of age, women were significantly less likely to describe their relationship as extremely physically and/or emotionally satisfying in every model, except those including generation (Tables 3 and 5, Models 1–4). Women were also less likely to report not-so-emotionally-satisfying relationships with advancing age (Table 5, Models 1–4). Although the proportion of emotionally-dissatisfied women varied little by age, the proportion of extremely-satisfied women decreased (i.e., women shifted from “extremely” to “very” happy). These age effects became non-significant for women and men when generation was added to the models (Tables 3 and 5, Model 5, and Table 6, Model 5, respectively).

Discussion

Individual Level Factors

Poor health negatively affected men’s physical pleasure, as hypothesized (H1 and H1a); however, health affected women’s emotional rather than physical satisfaction. Sex differences in morbidity may help to explain this pattern. Many illnesses affect sexual functioning in men disproportionately and men suffer from them at earlier ages than do women (Schiavi, 1994). The women in our sample may simply have been too young for poor health to impair their physical sexual pleasure. Insofar as good and poor health were associated with lower levels of emotional satisfaction among women, it may be that healthy women have higher expectations for sex, and so are more easily dissatisfied, while less-healthy women experience emotional frustration due to the inability to have sex in favored ways. Similarly, our prediction that sexual problems would affect physical rather than emotional pleasure (H2a) held true for men (in models excluding sexual practices), whereas women with sexual problems reported significantly lower levels of both physical and emotional pleasure. These patterns—which are broadly consistent with previous research (Huyck, 1994; Marsiglio & Greer, 1994; Schiavi, 1994; Segraves & Segraves, 1995)—suggest that these two dimensions of sexual satisfaction may be more closely intertwined for women than for men. For men, health and sexual problems appeared to diminish sexual satisfaction insofar as they impacted sexual practices, whereas for women, the effects of sexual problems and health remained independent, persisting as variables measuring sexual practices were incorporated into the model.

Previous research can shed some light on our unanticipated findings about racial/ethnic background and education. Belonging to a racial/ethnic minority was associated with lower levels of physical satisfaction only for women, while higher education was associated with lower levels of emotional satisfaction only for men. These findings contrast with research showing greater enjoyment among Blacks than Whites (Henderson-King & Veroff, 1994) and fewer sexual problems among the college educated (Laumann et al., 1994), but are consistent with the claim that such differences may stem from cultural/educational differences in ways of talking about sex and using survey scale options (Bancroft et al., 2003). Perhaps physical sexual pleasure is more subject to systematic racial/ethnic differences in women’s ways of talking about sex, while emotional satisfaction is more subject to educational differences in men’s talk about sex. It could also be that some aspect of higher education raised men’s expectations about the emotional aspects of sexual relationships, such that they found real life more disappointing than men whose expectations had not been raised thusly.

Relationship Level Factors

The relationship variables we tested were, by and large, poor predictors of sexual satisfaction (H3). Although many studies have linked relationship duration to sexual satisfaction, we found no such association in any of the models we tested, among men or women. For women, the only relationship-related variables associated with satisfaction were cohabitation status (physical) and time-partner-known-before-sex (emotional). Cohabitation status did not predict women’s physical satisfaction once sexual practices were introduced into the model, suggesting that bodily practices (which may differ by cohabitation status) were more central to women’s physical pleasure. For men, the only significant relationship variable was cohabitation status, which predicted greater physical pleasure until sexual attitudes were included in the model.

We suspect that disapproval of sex without love reflected an emotional dimension of participants’ actual relationships rather than simply a cultural orientation toward sex. To the extent that beliefs about sex without love reflected the quality of participants’ relationships, relationship quality appeared to be a better predictor of satisfaction for men than women. Disapproval of sex without love was associated with greater emotional pleasure for both genders, and with greater physical pleasure for men only. Causality should be interpreted with caution. Beliefs may shape behavior, such that people who disapproved of sex without love had sex only with beloved partners, and their love enhanced sexual satisfaction. Alternatively, men may have interpreted physically pleasurable sex as a sign of love, and then associated love with sex. People in satisfying sexual relationships may have declared that sex should be confined to loving couples because that was their own experience, whereas less-satisfied people may have distinguished love and sex because they had been separate in their own lives.

Our findings of greater emotional pleasure among women who knew their partners well before sex and among men and women who disapproved sex without love supported our prediction that relationship factors would have greater bearing on emotional than physical satisfaction (H3a), while the findings that men who cohabited and men who disapproved of sex without love experienced more physical pleasure suggested that relationship factors have more bearing on physical pleasure. In short, our research partially challenged and partially supported the commonsense assumption that emotional factors primarily affect emotional happiness. By a similar token, we found mixed evidence about gender differences (no H). Some relationship-related factors affected women and men differently, while others acted in similar ways. These mixed findings are consistent with the literature, but somewhat unusual in a single study.

Partner’s age, our proxy for partner’s health and sexual function, significantly predicted emotional rather than physical enjoyment (supporting H4 but contra H4a), but only for women, and only in models excluding generation. This suggested that older women’s partners, almost all of them still-older men, may disproportionately lack skills related to the emotional aspects of sex, even when relationships are otherwise loving. Such skills may vary by generation, rather than age per se (Ehrenreich, Hess, & Jacobs, 1986). A study using direct measures of partner’s health and sexual function would help to unravel this relationship further. Moreover, exceedingly few men had partners older than 59, the ages at which aging-related changes in health and sexual function become increasingly common among women.

For women, physical satisfaction and emotional pleasure were both associated with the frequency and duration of sexual encounters, and physical satisfaction was additionally linked with the regularity of orgasm. In contrast, for men, physical satisfaction was associated only with sexual duration and emotional pleasure only with sexual frequency. Broadly speaking, these findings were as we hypothesized (H5); however, our predictions of greater effects on physical pleasure (H5a) and among men (H5b) were not supported. Indeed, bodily sexual practices appeared to be better predictors of physical and emotional satisfaction for women than relational factors, whereas for men, relational factors seemed to be better predictors of both types of satisfaction. This counterintuitive finding should prompt additional study. It is possible that previous studies have overstated gender differences; or, alternatively, that men and women’s approaches to sex grow more similar over the life course (our study considers later life stages than most work on sexual satisfaction).

Regarding specific sexual practices, although sexual encounters longer than 15 min predicted enhanced physical pleasure for both genders, women reported significantly more satisfaction if their encounters lasted 16–29 or 30+ min, whereas, for men, only 16–29 min encounters predicted greater satisfaction. Relatively lengthy sexual encounters may have contributed to greater physical pleasure for both sexes through the physiological mechanisms that promote arousal and climax; however, our research suggested that women’s threshold for “long enough” sex was higher than men’s, perhaps because women achieve arousal and orgasm more slowly. This stands in contrast to studies in which men offer significantly longer ideal intercourse times than women (Miller & Byers, 2004); but supports findings that men rate rapid ejaculation as more troubling than do their female partners (Byers & Grenier, 2003). Notably, regular orgasms were also a significant predictor of physical pleasure for women, suggesting that longer encounters were important in their own right. Longer encounters may have enhanced women’s emotional sexual satisfaction by allowing for more romantic expression between partners or by indicating that one’s partner was concerned with ensuring mutual pleasure, which knowledge might have heightened satisfying feelings of intimacy. (Conversely, people who were emotionally dissatisfied with their sexual partners may have avoided prolonged sexual encounters). Our analyses also indicated gendered thresholds for “regular enough” orgasms, consistent with previous research. For men, for whom orgasm during sex is understood as routine, regularity of orgasms was not predictive of sexual satisfaction; but for women, for whom orgasms during vaginal sex are less routine, climaxing only sometimes (versus always) reduced physical pleasure. Our failure to find a positive association between varied sexual practices and sexual enjoyment could have stemmed from our narrow measure of variety (limited to oral sex, due to dataset limitations).

As noted, bodily practices evinced somewhat different relationships to physical and emotional pleasure, but not as we expected (H5a). For women, sexual frequency and duration were associated with both aspects of pleasure, but orgasm was linked only with physical satisfaction. This finding helps to illuminate a tension in the literature, whereby some studies find orgasm to be relatively unimportant to women’s sexual pleasure (Nicolson & Burr, 2003) while others find just the opposite (Haavio-Mannila & Kontula, 1997). For men, physical satisfaction was associated only with sexual duration and emotional pleasure only with sexual frequency. These patterns make sense considering that sexual duration depends largely on physiological phenomena like erectile capacity, while the emotional quality of a couple’s relationship would likely be linked to the frequency with which they have sex.

Cultural Level Factors

Our hypothesis that traditional sexual beliefs would predict lower levels of satisfaction (H6) received scant support. Women who agreed that men have greater sexual needs reported less physical pleasure than women who disagreed, but this relationship did not hold true for men (supporting H6a) or for emotional satisfaction for either gender. This pattern suggested that subscribing to traditional views of masculine sexuality, which may be more difficult to embody with advancing age, did not impair either aspect of men’s sexual satisfaction; while holding traditional views of women’s sexuality, which may imply a greater emphasis on youthful appearance, decreased women’s physical but not emotional pleasure. (Alternatively, women who did not particularly enjoy sex may, accordingly, have felt they needed sex less than men do).

Our findings about beliefs about sex without love and premarital sex likewise tended to disconfirm our hypothesis (H6). In contrast with studies linking permissive sexual attitudes with greater sexual satisfaction (Haavio-Mannila & Kontula, 1997), beliefs about premarital sex did not predict levels of sexual satisfaction in any of the models we tested. Moreover, approval of sex without love predicted less physical and emotional satisfaction among men and less emotional satisfaction among women. As noted, we suspect that these patterns reflected the impact of relationship quality on sexual satisfaction, rather than the broader cultural processes our hypotheses was intended to tap.

Finally, our analyses supported the hypothesis that age effects on sexual satisfaction would be mediated by generation (H7). Although previous research indicates that sexual satisfaction declines with advancing age, especially for women, few studies adequately distinguish between age and generation. As in other research, women in our study expressed less physical and emotional satisfaction with advancing years, whereas men reported greater emotional satisfaction at older ages. Liu (2003), also using NHSLS data, suggested that this pattern may be an artifact of relationship duration; but he did not distinguish age from cohort. The age effects we found became non-significant when generation was added to the models, suggesting that these age patterns were largely due to differences between the Baby Boom and WWII cohorts. It therefore appears that is it not age per se, but generation that influenced women’s and men’s sexual satisfaction. However, the generation effect was not strong enough (or was too intertwined with other variables) for generation to be a significant predictor of satisfaction in its own right.

Notably, the effect of generation cannot be reduced to cohort differences in sexual attitudes, for these were independent predictors of sexual satisfaction. More complex forces appeared to be at work. For example, Baby Boomer women may have systematically described their sexual experiences using more dramatic terms than older women (i.e., Boomers’ “extremely” may be older women’s “very”); perhaps they were socialized to express more enthusiasm about sex. It could also be that the pre-Boom generation had to a greater extent internalized the image of older women as sexually undesirable; thus, they may have perceived themselves as less sexy as they age, and gotten less emotional (or even physical) enjoyment from sex accordingly.

Conclusion

Taken together, our analyses highlight the nuanced ways in which gender, age, and generation shape the physical and emotional dimensions of sexual satisfaction. Overall, we found the factors contributing to sexual satisfaction to be more numerous and complex for women than for men. Contrary to popular assumptions, bodily sexual practices appeared to be better predictors of physical and emotional satisfaction for women than relational factors, whereas for men, relational factors seemed to be better predictors of both types of satisfaction. As anticipated, physical and emotional sexual satisfaction were influenced by somewhat different factors, but not always in the way commonsense assumptions would predict. Although women expressed less physical and emotional satisfaction with advancing years, while men reported greater emotional satisfaction at older ages, these age effects became non-significant when generation was added to the models, suggesting that generational differences between the Baby Boom and WWII cohorts underlay patterns by age.

At the outset of this article, we stressed the need to know more about the relative importance of biological, cultural, and psychological factors in explaining variations in sexual life. Our findings revealed how all three dimensions of human life, along with relational factors (which are not reducible to psychology), worked together in complicated, sometimes unexpected ways, to shape sexual satisfaction. Our research also advanced knowledge about the subjective aspects of sexuality by linking levels of self-reported satisfaction to the more easily quantifiable factors on which so much sexuality research focuses. Sexual frequency, duration, and regularity of orgasm were (positively) associated with sexual satisfaction, as were objectively-measured sexual “problems” (negatively), in ways complicated by gender, generation, and age.

Our research can be usefully extended in several ways. By collecting longitudinal data on sexuality, scholars could more effectively disentangle the effects of aging from those of cohort and begin to assess questions of cause and effect. In-depth interviews and other qualitative methods could help to illuminate middle-aged women and men’s subjective understandings of sexual satisfaction and the means through which they attempt to enhance it. It would also be useful to examine the same issues among women and men aged 60 and older, especially as life expectancies continue to rise, and to chart the sexual lives of the Baby Boomers as they age. Future research could utilize additional, more direct measures of relationship quality and distinguish sexual problems that cause distress from those that do not.

A positive end in its own right, satisfying sexual activity is integral to mental health and associated with marital/relationship stability (Ade-Ridder, 1990; SIECUS, 2002). Sexual satisfaction is also seen as a hallmark of healthy/successful aging, among those who subscribe to that paradigm. Our findings about gender and sexual satisfaction in midlife recommend optimism as well as concern. On the upside, contrary to popular stereotypes, the majority of sexually-active middle-aged heterosexual women and men are highly satisfied with the physical and emotional dimensions of their sexual relationships. On the downside, a sizeable minority of middle-aged heterosexual men and especially women describe their sexual lives as mediocre at best. Both genders would benefit from efforts to improve the overall health of older adults; to treat aging-related illnesses in ways that have fewer adverse effects on sexual life; and to counteract the ageist and sexist images that pervade American popular culture. Older women might also gain from initiatives aimed at enhancing the sexual techniques of their male partners.

Our counterintuitive findings about the importance of bodily practices for women’s sexual satisfaction and the importance of relationships for men’s provide particular food for thought. Why, for instance, does the cultural belief that men’s sexual happiness is relatively independent from relational factors persist, when scholarly research regularly demonstrates otherwise? Our research also supports scholars (e.g., Calasanti & Slevin, 2001; Loe, 2001) who warn that Viagra alone cannot ensure men’s sexual happiness, insofar as relationships play an important role in men’s sexual satisfaction. For women, whose pleasure depends in large part on physical aspects of sex (contrary to widespread assumptions), medical sexual treatments should prove helpful, but not sufficient—for, as we have shown, the underpinnings of women’s sexual satisfaction are complex. The relational nature of men’s sexual satisfaction is cause for optimism for both genders—for men may well be eager to learn new ways of bringing their women partners physical pleasure.