Estimating the Prevalence of Sexual Function Problems: The Impact of Morbidity Criteria

Figures & data

Table 1. Sexually active population demographics

	Men		Women
Unweighted, weighted denominators	4840, 5975		6669, 5755
	Percent	95% C.I.	Percent	95% C.I.
Age group
16–24	15.7%	(14.7–16.7)	16.0%	(15.2–16.9)
25–34	20.7%	(19.5–21.9)	21.6%	(20.7–22.6)
35–44	21.7%	(20.2–23.3)	22.4%	(21.2–23.7)
45–54	19.9%	(18.4–21.3)	20.6%	(19.3–22.0)
55–64	14.2%	(13.0–15.5)	13.1%	(12.1–14.2)
65–74	7.8%	(7.0–8.7)	6.2%	(5.5–6.9)
Marital status
Married or civil partnership	54.7%	(53.1–56.3)	55.2%	(53.7–56.6)
Cohabitation	14.7%	(13.6–15.8)	14.2%	(13.2–15.2)
Previously married	6.0%	(5.4–6.6)	8.3%	(7.6–9.1)
Single and never married	24.6%	(23.3–25.9)	22.3%	(21.3–23.4)
Ethnic origin
White	88.6%	(87.4–89.7)	89.5%	(88.5–90.3)
Mixed	1.6%	(1.2–2.0)	2.0%	(1.7–2.4)
Asian or Asian British	5.6%	(4.8–6.5)	4.4%	(3.8–5.0)
Black or Black British	3.2%	(2.6–4.0)	3.1%	(2.6–3.7)
Other	1.0%	(0.7–1.5)	1.1%	(0.8–1.4)
Self-defined sexual identity
Heterosexual/straight	97.3%	(96.7–97.8)	97.1%	(96.6–97.5)
Gay/lesbian	1.5%	(1.2–2.0)	1.1%	(0.9–1.4)
Bisexual	1.1%	(0.8–1.5)	1.6%	(1.3–1.9)
Other	0.1%	(0.0–0.2)	0.2%	(0.1–0.4)
National Statistics Socio-Economic Classification
Managerial and professional occupations	38.8%	(37.1–40.5)	33.7%	(32.4–35.1)
Intermediate occupations	17.3%	(16.0–18.7)	21.1%	(19.9–22.2)
Semiroutine and routine occupations	32.3%	(30.7–33.9)	26.9%	(25.7–28.1)
Never worked and long-term unemployed	4.4%	(3.8–5.1)	10.9%	(10.1–11.9)
Full-time students	7.2%	(6.5–8.1)	7.4%	(6.7–8.1)
Quintile of Index of Multiple Deprivation^a
1 [least deprived]	21.4%	(19.9–23.0)	21.0%	(19.6–22.5)
2	21.2%	(19.6–22.8)	21.0%	(19.5–22.5)
3	19.6%	(18.1–21.1)	19.4%	(18.0–20.8)
4	19.8%	(18.3–21.4)	19.7%	(18.4–21.2)
5 [most deprived]	18.0%	(16.6–19.5)	18.9%	(17.6–20.2)

^a A multidimensional measure of area (neighbourhood)-level deprivation based on the participant’s postcode; Index of Multiple Deprivation scores for England, Scotland, and Wales were adjusted before assignment to quintiles by use of a method by Payne and Abel (2012).

Table 2. Percentage of sexually active men and women reporting sexual function problems for at least three months in the last year and proportion reporting problems meeting DSM-5 morbidity criteria

	Of those reporting the problem
	Population % reporting problem	Lasting 6 months or more	Always/very often symptomatic	Fairly/very distressing	Meets all 3 DSM-5 criteria	Population % meeting DSM-5 morbidity criteria
Men (Unw 4840; W 5975)
Lacked interest in having sex	15.0%	35.1%	32.2%	14.4%	5.2%	0.8%
95% C.I.	(13.9–16.2)	(31.0–39.4)	(28.3–36.3)	(11.8–17.5)	(3.6–7.5)	(0.5–1.1)
Trouble getting or keeping an erection	12.9%	64.2%	26.7%	40.9%	14.1%	1.8%
95% C.I.	(11.8–14.0)	(59.6–68.4)	(22.8–30.8)	(36.5–45.5)	(11.3–17.5)	(1.4–2.3)
Difficulty in reaching climax	9.2%	43.7%	16.3%	17.3%	5.5%	0.5%
95% C.I.	(8.3–10.1)	(38.6–49.0)	(12.9–20.4)	(13.6–21.7)	(3.5–8.5)	(0.3–0.8)
Reached climax more quickly than you would like	14.9%	53.3%	29.9%	22.2%	11.6%	1.7%
95% C.I.	(13.7–16.2)	(48.9–57.7)	(26.2–33.9)	(18.8–25.9)	(9.0–14.7)	(1.3–2.2)
Experienced one or more of these problems	38.2%	53.0%	32.8%	24.9%	11.1%	4.2%
95% C.I.	(36.6–39.8)	(50.3–55.7)	(30.4–35.3)	(22.7–27.2)	(9.5–12.9)	(3.6–5.0)
Women (Unw 6669; W 5755)
Lacked interest and arousal	6.5%	55.8%	33.1%	23.8%	9.1%	0.6%
95% C.I.	(5.9–7.2)	(50.3–61.1)	(27.8–38.8)	(19.6–28.6)	(6.4–12.8)	(0.4–0.9)
Difficulty in reaching climax	16.3%	52.9%	39.0%	22.0%	11.6%	1.9%
95% C.I.	(15.3–17.3)	(49.5–56.3)	(35.7–42.5)	(19.4–24.8)	(9.7–13.8)	(1.6–2.3)
Felt physical pain as a result of sex	7.4%	62.1%	50.8%	45.5%	25.0%	1.9%
95% C.I.	(6.7–8.3)	(57.1–66.8)	(45.6–56.1)	(40.5–50.5)	(20.7–29.8)	(1.5–2.3)
Experienced one or more of these problems	22.8%	55.5%	43.6%	28.8%	16.0%	3.6%
95% C.I.	(21.7–24.0)	(52.5–58.4)	(40.6–46.6)	(26.3–31.4)	(14.0–18.2)	(3.2–4.2)

Unw = unweighted denominator; W = Weighted denominator

Figure 1. Prevalence of sexual function problems meeting DSM-5 morbidity criteria in the last year by gender and age group, among the sexually active participants.

Table 3a Overlap between reported sexual function problems meeting DSM-5 morbidity criteria: Sexually active men

	Percentage also experiencing:
Men	Lacked interest in having sex		Trouble getting or keeping an erection		Difficulty in reaching climax		Reached climax more quickly than you would like		Any of the other problems in table		Denominators
	%	95% CI	%	95% CI	%	95% CI	%	95% CI	%	95% CI	Unw W
Lacked interest in having sex	-	-	12.4%	(5.2–26.8)	15.5%	(6.3–33.3)	17.4%	(7.4–35.7)	35.9%	(20.6–54.7)	37, 46
Trouble getting or keeping an erection	5.4%	(2.3–11.9)	-	-	10.8%	(5.4–20.3)	3.0%	(1.0–8.5)	16.5%	(9.9–26.2)	82, 108
Difficulty in reaching climax*	NA	-	NA	-	-	-	NA	-	NA	-	22, 30
Reached climax more quickly than you would like	7.9%	(3.3–17.4)	3.2%	(1.1–8.9)	1.5%	(0.2–10.1)	-	-	11.0%	(5.6–20.6)	82, 103

* Numbers too small to permit analysis

Table 3b. Overlap between reported sexual function problems meeting DSM-5 morbidity criteria: Sexually active women

	Percentage also experiencing:
Women	Lacked interest and arousal in having sex		Difficulty in reaching climax		Felt physical pain as a result of sex		Any of the other problems in the table		Denominators
	%	95% CI	%	95% CI	%	95% CI	%	95% CI	Unw W
Lacked interest and arousal in having sex	-	-	57.8%	(40.1–73.6)	33.4%	(18.6–52.4)	71.6%	(54.4–84.2)	42, 34
Difficulty in reaching climax	18.1%	(11.5–27.5)	-	-	14.1%	(8.6–22.2)	26.1%	(18.2–35.9)	145, 109
Felt physical pain as a result of sex	10.7%	(5.8–18.7)	14.3%	(8.7–22.7)	-	-	18.8%	(12.2–27.8)	119, 107

Table 4. Associations between sexual function problems meeting DSM-5 morbidity criteria and factors relevant to etiology and management

	Men						Women
	%	95% C.I.	aAOR	95% C.I.	p-value	Denominators^a	%	95% C.I.	aAOR	95% C.I.	p-value	Denominators^a
Overall	4.2%	(3.6–5.0)	-	-	-	4840, 5975	3.6%	(3.2–4.2)	-	-	-	6669, 5755
Age group					0.0002						0.0171
16–24	2.3%	(1.6–3.4)	1.00			1279, 936	4.4%	(3.5–5.6)	1.00			1662, 923
25–34	3.7%	(2.6–5.1)	1.59	(0.95–2.64)		1376, 1238	4.2%	(3.3–5.3)	0.94	(0.67–1.33)		2236, 1246
35–44	3.5%	(2.5–5.1)	1.52	(0.91–2.55)		719, 1298	2.8%	(1.9–4.0)	0.61	(0.39–0.96)		1050, 1290
45–54	4.1%	(2.6–6.2)	1.77	(1.00–3.13)		630, 1186	3.1%	(2.1–4.6)	0.68	(0.42–1.10)		871, 1186
55–64	6.6%	(4.7–9.2)	2.93	(1.74–4.94)		512, 849	5.3%	(3.6–7.7)	1.20	(0.74–1.93)		569, 755
65–74	7.6%	(5.0–11.6)	3.43	(1.89–6.24)		324, 469	1.3%	(0.5–3.3)	0.29	(0.11–0.75)		281, 355
PARTNER AND RELATIONSHIP FACTORS
Partner had sexual difficulties past year					0.0676						0.0002
No	3.8%	(3.0–4.7)	1.00			2431, 3454	3.2%	(2.6–3.9)	1.00			3726, 3498
Yes	6.1%	(4.1–8.9)	1.59	(0.97–2.61)		513, 763	6.4%	(4.6–8.8)	2.26	(1.47–3.48)		649, 719
Always easy to talk about sex with partner					0.0001						0.0057
Yes	2.2%	(1.5–3.1)	1.00			1695, 1899	2.5%	(1.8–3.4)	1.00			1746, 1451
Else	5.2%	(4.4–6.2)	2.26	(1.50–3.42)		3123, 4050	4.0%	(3.5–4.7)	1.66	(1.16–2.38)		4907, 4289
Partner shares same interest level in sex					<0.0001						<0.0001
Yes	3.1%	(2.4–4.0)	1.00			2270, 3233	2.0%	(1.5–2.6)	1.00			3211, 3064
No	7.7%	(5.7–10.3)	2.65	(1.75–4.02)		676, 988	8.3%	(6.7–10.3)	4.43	(3.07–6.39)		1166, 1155
Partner shares same sexual likes and dislikes					0.0001						<0.0001
Yes	3.7%	(2.9–4.6)	1.00			2650, 3803	3.1%	(2.6–3.8)	1.00			4079, 3908
No	9.0%	(6.0–13.2)	2.65	(1.61–4.35)		296, 418	11.2%	(7.9–15.7)	3.92	(2.54–6.03)		297, 310
INDIVIDUAL VULNERABILITY
Felt anxious during sex					<0.0001						<0.0001
No	3.4%	(2.8–4.1)	1.00			4548, 5651	2.5%	(2.1–3.0)	1.00			6264, 5453
Yes	19.4%	(15.0–24.9)	7.46	(5.12–10.87)		292, 324	23.5%	(18.8–28.9)	12.15	(8.55–17.25)		405, 302
Experienced non-volitional sex, ever^b					0.1269						<0.0001
No	4.1%	(3.5–4.9)	1.00			4706, 5825	3.1%	(2.6–3.6)	1.00			5815, 5055
Yes	7.9%	(3.2–18.3)	2.09	(0.81–5.40)		71, 82	8.9%	(6.8–11.6)	3.10	(2.21–4.35)		684, 579
Unemployed last week					0.0198						0.8154
No	3.6%	(2.9–4.4)	1.00			3277, 4307	3.7%	(3.1–4.4)	1.00			4001, 3597
Yes	6.0%	(4.6–7.7)	1.53	(1.07–2.19)		1560, 1666	3.6%	(2.8–4.4)	0.97	(0.73–1.29)		2662, 2152
Current depression (PHQ-2)^c					<0.0001						<0.0001
No	3.5%	(2.9–4.2)	1.00			4384, 5472	3.0%	(2.6–3.6)	1.00			5885, 5149
Yes	12.4%	(9.1–16.6)	4.17	(2.77–6.26)		449, 495	8.9%	(6.9–11.5)	3.12	(2.25–4.33)		780, 602
CULTURAL/RELIGIOUS FACTORS
Religion important and practiced regularly					0.6125						0.1346
No	4.2%	(3.5–4.9)	1.00			4481, 5453	3.8%	(3.3–4.4)	1.00			6047, 5100
Yes	5.2%	(3.1–8.6)	1.16	(0.65–2.07)		349, 506	2.4%	(1.3–4.3)	0.62	(0.33–1.16)		609, 644
Sex without love is OK					0.9122						0.1004
No	4.5%	(3.4–5.8)	1.00			1586, 2097	3.2%	(2.5–4.0)	1.00			3291, 2968
Yes	4.2%	(3.4–5.1)	1.02	(0.72–1.45)		3233, 3852	4.1%	(3.4–5.0)	1.29	(0.95–1.76)		3347, 2761
People are under pressure to have sex					0.1817						0.0158
No	3.7%	(2.8–4.9)	1.00			1737, 2176	2.6%	(1.9–3.6)	1.00			1761, 1485
Yes	4.6%	(3.8–5.6)	1.28	(0.89–1.85)		3039, 3708	4.1%	(3.5–4.8)	1.61	(1.09–2.37)		4817, 4185
MEDICAL FACTORS
Number of self-reported chronic conditions^d					<0.0001						<0.0001
0	3.0%	(2.4–3.8)	1.00			3456, 3996	2.5%	(2.0–3.1)	1.00			4357, 3536
1	4.6%	(3.4–6.1)	1.39	(0.90–2.16)		920, 1302	4.5%	(3.5–5.8)	2.07	(1.47–2.92)		1544, 1405
2+	11.0%	(8.0–14.8)	3.35	(2.03–5.51)		464, 678	7.1%	(5.2–9.6)	3.90	(2.60–5.85)		767, 814
Health condition affecting sexual activity or enjoyment					<0.0001						<0.0001
No	2.3%	(1.8–2.9)	1.00			4170, 5061	1.8%	(1.5–2.2)	1.00			5515, 4712
Yes	15.0%	(12.2–18.4)	6.89	(4.81–9.86)		656, 898	11.9%	(9.8–14.4)	7.44	(5.48–10.09)		1147, 1038
Medication that affected sexual activity last year					<0.0001						<0.0001
No	3.3%	(2.8–4.1)	1.00			4492, 5513	2.9%	(2.5–3.5)	1.00			6170, 5318
Yes	15.2%	(11.4–19.9)	4.46	(2.96–6.72)		332, 444	12.4%	(9.4–16.2)	4.67	(3.27–6.69)		492, 431
Uncomfortably dry vagina					-						<0.0001
No	-	-	-	-		-	2.3%	(1.9–2.7)	1.00			5920, 5010
Yes	-	-	-	-		-	13.0%	(10.4–16.1)	7.19	(5.23–9.87)		749, 746

aAOR = age-Adjusted Odds Ratio; PHQ-2 = Patient Health Questionnaire-2

^a Unweighted, weighted denominators

^b Defined as anyone having sex with you against your will after the age of 13 years

^c Two screening questions (scored 0–3 per question; defined here by a total score of 3 or more) assessed depressive symptoms (PHQ-2; Arroll, 2003; Arroll et al., 2010)

^d Includes arthritis, heart attack, coronary heart disease, angina, other forms of heart disease, hypertension, stroke, diabetes, broken hip or pelvis bone or hip replacement ever, backache lasting longer than 3 months, any other muscle or bone disease lasting longer than 3 months, depression, cancer, and any thyroid condition treated in the past year

Figure 2. Proportion of men and women with sexual function problems meeting DSM-5 morbidity criteria who sought professional help in the last year.

Box 1. Criteria for sexual function problems: Comparison of Natsal-3 survey and DSM-5

DSM-5 diagnostic criteria: Verbatim extracts from DSM-5 (American Psychiatric Association, 2013, pp. 423‒450)	Natsal-3 survey item
MORBIDITY CRITERIA
Morbidity criteria for each difficulty Symptoms experienced on almost all or all occasions (approx. 75–100%)* Symptoms must have been present for at least 6 months Symptoms cause clinically significant distress in the individual * Note that for Male Hypoactive Sexual Desire Disorder (HSDD) and Genito-Pelvic Pain/Penetration Disorder, symptoms should be ‘persistent or recurrent’ rather than occurring ‘always or almost always’	Report if difficulty experienced for three months or more in last year. Items on morbidity asked for each difficulty endorsed Morbidity criteria for each difficulty: Symptoms occur ‘very often’ or ‘always’ Experienced for at least 6 months Participant is ‘fairly distressed’ or ‘very distressed’ about the difficulty
FEMALE PROBLEMS
Female Orgasmic DisorderEither of the following symptoms: Marked delay in, marked infrequency, or absence of orgasm. Markedly reduced intensity of orgasmic sensation.	Did not reach a climax (experience an orgasm) or took a long time to reach a climax despite feeling excited or aroused
Female Sexual Interest/Arousal disorder (FSIAD). Diagnosis requires 3 or more of the following symptoms: Absent/reduced interest in sexual activity. Absent/reduced sexual/erotic thoughts or fantasies. No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate. Absent/reduced sexual excitement/pleasure during sexual activity on almost all or all (approximately 75%–100% of) sexual encounters (in identified situational contexts or, if generalized, in all contexts). Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (e.g., written, verbal, visual). Absent/reduced genital or nongenital sensations during sexual activity on almost all or all (approximately 75%–100% of) sexual encounters (in identified situational contexts or, if generalized, in all contexts).	Reported BOTH of these items: Lacked interest in having sex Felt no excitement or arousal during sex
Genito Pelvic Pain/Penetration disorder.Persistent or recurrent difficulty with one or more of the following: Having vaginal intercourse/penetration. Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts. Marked fear or anxiety either about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration. Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.	Felt physical pain as a result of sex
MALE PROBLEMS
Delayed ejaculation Either of the following symptoms: Marked delay in ejaculation Marked infrequency or absence of ejaculation	Did not reach a climax (experience an orgasm) or took a long time to reach a climax despite feeling excited or aroused
Erectile Disorder: At least one of the following: Marked difficulty in obtaining an erection during sexual activity. Marked difficulty in maintaining an erection until the completion of sexual activity. Marked decrease in erectile rigidity.	Had trouble getting or keeping an erection
Male Hyposexual Desire Disorder: Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity.	Lacked interest in having sex
Premature (Early) Ejaculation: A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it.	Reached climax (experienced an orgasm) more quickly than you would like

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