Prevalence Rates of Sexual Difficulties and Associated Distress in Heterosexual Men and Women: Results From an Internet Survey in Flanders

Abstract

As most epidemiological surveys on sexual problems have not included assessment of associated distress, the principal aim of this study was to provide prevalence estimates of both DSM-IV-TR-defined (American Psychiatric Association [APA], 2000) and less commonly assessed sexual difficulties and dysfunction (e.g., lack of responsive sexual desire, lack of subjective arousal). A secondary aim was to obtain information about comorbidity between sexual desire and sexual arousal difficulties/dysfunction. This study comprised an online survey completed by 35,132 heterosexual Flemish men and women (aged 16 to 74 years). Results indicated that sexual dysfunctions were far less common than sexual difficulties, and some uncommonly assessed sexual problems (e.g., “lack of responsive desire” in women; “hyperactive sexual desire” in men) were quite prevalent. In women, there was a high comorbidity between “lack of spontaneous sexual desire” and “lack of responsive sexual desire”; between “lack of genital arousal” and “lack of subjective sexual arousal”; and between sexual desire and sexual arousal difficulties/dysfunctions. The implications of these findings for epidemiological research on sexual dysfunction and for the newly defined DSM-5 Female Sexual Interest/Arousal Disorder (APA, 2013) are discussed.

Acknowledgments

We would like to thank the collaborators of Ook getest op mensen from the Flemish public broadcasting company (VRT) who provided us the unique opportunity to undertake this online survey. We are especially grateful to Berten Baert, Maarten Boone, Hendrik Dacquin, Niels Laukens, and Jeroen van Aert for their help in data acquisition.

Notes

Note. Brackets indicate that the number from which percentage is computed is < 50.

Note. Brackets indicate that the number from which percentage is computed is < 50.

¹The trimmed mean is a procedure to trim down the ends of a distribution, thereby removing the outliers that skew and bias the mean. The trimmed mean produces accurate results even when the distribution is not symmetrical (Field, 2009). In this study, the 5% trimmed mean of duration was 266 seconds, which came close to the median duration of 250 seconds.

^a Sexual difficulty denotes moderately or severely impaired sexual function (score ≥2 on difficulty questions).

^b Sexual dysfunction denotes moderately or severely impaired sexual function that caused moderate or severe distress (score on sexual difficulty question ≥2) AND (if partner: score ≥5 on three types of distress; if no partner: score ≥2 on personal distress).

^c Due to rounding issues, the total percentage of the sexual difficulties is not the exact sum of prevalence of moderately and severely impaired sexual function.

^d The prevalence rate of lack of responsive desire is based on the data of men with a partner (N = 15,842).

^e Erectile difficulty was defined as “difficulty in attaining and/or maintaining an erection sufficient for penetration.”

^f Prevalence of dyspareunia in men was calculated on N = 16,175. Men who could not or never penetrate their partner have been left out (unclear whether this was due to pain in men or pain in women).

^g DSM-IV-TR-defined sexual difficulties included sexual aversion, hypoactive sexual desire, erectile difficulty, absent/delayed orgasm, premature ejaculation, and dyspareunia.

^a Sexual difficulty denotes moderately or severely impaired sexual function (score ≥2 on difficulty questions).

^b Sexual dysfunction denotes moderately or severely impaired sexual function that caused moderate or severe distress (score on sexual difficulty question ≥2) AND (if partner: score ≥5 on three types of distress; if no partner: score ≥2 on personal distress).

^c The prevalence rate of lack of responsive desire is based on the data of women with a partner (N = 15,641).

^d Lubrication difficulty was defined as “difficulty attaining and/or maintaining lubrication.”

^e Due to rounding issues, the total percentage of the sexual difficulties is not the exact sum of prevalence of moderately and severely impaired sexual function.

^f DSM-IV-TR-defined sexual difficulties included sexual aversion, hypoactive sexual desire, lubrication difficulty, absent/delayed orgasm, and dyspareunia.

^a Women reporting a lack of genital sexual arousal but not a lack of subjective sexual arousal.

^b Women reporting a lack of subjective sexual arousal but not a lack of genital sexual arousal.

^c Women reporting both a lack of genital sexual arousal and a lack of subjective sexual arousal.

^d Women reporting a lack of spontaneous sexual desire but not a lack of responsive sexual desire.

^e Women reporting a lack of responsive sexual desire but not a lack of spontaneous sexual desire.

^f Women reporting both a lack of spontaneous sexual desire and a lack of responsive sexual desire.

^g Total percentage is slightly different from the sum of “pure spontaneous desire difficulty” components because cell percentages have been rounded.

^h Total percentage is slightly different from the sum of “combination of both types of desire dysfunction” components because cell percentages have been rounded.