Sexual problems among women and men aged 40-80 y: prevalence and ...

International Journal of Impotence Research (2005) 17, 39–57
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Sexual problems among women and men aged 40–80 y:
prevalence and correlates identified in the Global Study
of Sexual Attitudes and Behaviors
EO Laumann1*, A Nicolosi2,3, DB Glasser4, A Paik5, C Gingell6, E Moreira7 and T Wang1 for the GSSAB
Investigators’ Group
1University of Chicago, Chicago, USA; 2National Research Council, Milan, Italy; 3Columbia University, NY, USA; 4Pfizer
Inc, NY, USA; 5University of Iowa, IA, USA; 6Southmead Hospital, Bristol, UK; 7Oswaldo Cruz Foundation, Bahia, Brazil
The Global Study of Sexual Attitudes and Behaviors (GSSAB) is an international survey of various
aspects of sex and relationships among adults aged 40–80 y. An analysis of GSSAB data was
performed to estimate the prevalence and correlates of sexual problems in 13 882 women and 13 618
men from 29 countries. The overall response rate was modest; however, the estimates of prevalence
of sexual problems are comparable with published values. Several factors consistently elevated the
likelihood of sexual problems. Age was an important correlate of lubrication difficulties among
women and of several sexual problems, including a lack of interest in sex, the inability to reach
orgasm, and erectile difficulties among men. We conclude that sexual difficulties are relatively
common among mature adults throughout the world. Sexual problems tend to be more associated
with physical health and aging among men than women.
International Journal of Impotence Research (2005) 17, 39–57. doi:10.1038/sj.ijir.3901250
Published online 24 June 2004
Keywords: epidemiology; health surveys; impotence; prevalence; sexual disorders; risk factors
Introduction
American and Western European populations, find-
ings from other regions of the world are often based
on smaller studies involving clinical series or other
There is an ongoing debate regarding the nature of
samples that are not broadly representative. The
gender differences in sexual problems.1 One feature
Global Study of Sexual Attitudes and Behaviors
of this debate centers on the extent to which
(GSSAB) was recently conducted to investigate
biological, psychosocial, and cultural factors each
health status, as well as attitudes, beliefs, behaviors,
contribute to these various difficulties. Yet, assess-
and satisfaction regarding sex and relationships
ments of their relative influence on the prevalence
among middle-aged and older adults in 29 countries.
of sexual problems have been hampered by the lack
The objectives of the current analysis of the GSSAB
of systematic, cross-cultural population studies. A
include the following: (1) to estimate the prevalence
recent review of 52 studies on sexual dysfunctions,
of sexual problems among women and men for seven
for example, found that few were based on broadly
regional clusters and (2) to identify factors that
representative samples, and even fewer included
increase the likelihood of reporting selected, com-
information on multiple sexual problems in both
mon sexual problems by gender and regional cluster.
women and men.2 Indeed, the majority of studies
typically focus on erectile dysfunction (ED). With
most epidemiological studies focused on North
Methods
The GSSAB is the first large, multi-country survey
*Correspondence: EO Laumann, PhD, Department of
to systematically study attitudes, beliefs, and health
Sociology, University of Chicago, 5848 S University
in sexual relationships in middle-aged and older
Avenue, Chicago, IL 60637, USA.
E-mail: ob01@midway.uchicago.edu
adults. The survey involved 13 882 women and
Received 11 November 2003; revised 8 April 2004;
13 618 men, aged 40–80 years, in 29 countries,
accepted 20 May 2004
representing many world regions. In Europe (Austria,

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Risk factors for sexual problems
EO Laumann et al
40
Belgium, France, Germany, Italy, Spain, Sweden,
(5) ‘refusers’ were not called back in an effort to
and the United Kingdom), North America (Canada
convert them to participating respondents.
and USA), Australia, New Zealand, Israel, and
The questionnaire asked for information about
Brazil, samples were based on random-digit-dialing
demographics; health; relationships and general
and respondents were selected randomly within
satisfaction with life as a whole; as well as
households by asking for the person between 40
individual behavior, practices, attitudes, and beliefs
and 80 y of age with the most recent birthday.
regarding sexuality. The presence of sexual pro-
Sampling in Middle Eastern countries (Algeria,
blems was assessed using the following question:
Egypt, Morocco, and Turkey) employed a door-to-
‘During the last 12 months have you ever experi-
door protocol, where households were selected
enced any of the following for a period of 2 months
using random starting points, and the study staff
or more when you: (1) lacked interest in having sex;
contacted every third house in several major cities.
(2) were unable to reach climax (experience orgasm);
In Asian countries (China, Hong Kong (although
(3)
reached
climax
(experienced
orgasm)
too
Hong Kong is part of China, it is listed separately
quickly; (4) experienced physical pain during sex;
because of its distinct socioeconomic and cultural
(5) did not find sex pleasurable; (6) had trouble
characteristics), Korea, Indonesia, Malaysia, Philip-
achieving or maintaining an erection (men only);
pines, Singapore, Taiwan, and Thailand), an inter-
and (7) had trouble becoming adequately lubricated
cept protocol was employed in major cities. Both
(women only)?’. Respondents were permitted to
the door-to-door and intercept protocols represent
answer yes to all that applied. For those indicating
accepted survey methods for each country, but
the presence of a specific sexual problem, the
are likely to be more reflective of their urban
relative severity was assessed in a follow-up ques-
populations. The standard sample size of 1500
tion: ‘For each of these experiences, how often
(equal numbers of men and women) was used in
would you say this has occurred during the last 12
Germany, Sweden, UK, France, Italy, Spain, Aus-
months? Would you say that this has occurred
tralia, Turkey, and Japan. A sample size of 500 was
occasionally, sometimes, or frequently?’.
used in Austria, Belgium, New Zealand, Algeria,
We restricted our analyses to only those respon-
China, Hong Kong, Taiwan, Indonesia, Malaysia,
dents who had had intercourse at least once in the
Philippines, Singapore, and Thailand. In the re-
year prior to being interviewed. This procedure
maining countries, the sample sizes were: Israel 505,
reduced our sample size to 9000 women and 11 205
Canada 1007, South Africa 999, USA 1491, Brazil
men and tended to drop older respondents, who
1199, Mexico 506, Egypt 584, Morocco 509, and
were sexually inactive more frequently. Thus, the
Korea 1200.
prevalence of sexual problems was calculated by
In Europe, North America, Australia, New Zeal-
dividing the total number of self-reports for each
and, Israel, and Brazil, telephone interviews were
problem by the total number of respondents, who
conducted via Computer-Assisted Telephone Inter-
were sexually active in the year prior to being
view (CATI). Due to the sensitive nature of the topic,
interviewed, by gender. Country-specific data were
refusals were not called back. The door-to-door and
grouped into clusters, according to geographic
intercept protocols employed in Algeria, Egypt,
proximity, shared cultural backgrounds, and similar
Morocco, Turkey, China, Korea, Taiwan, Indonesia,
modes of data collection. Using the age distribution
Malaysia, the Philippines, Singapore, South Africa,
of the entire sample in the GSSAB for women and
and Thailand used self-completed questionnaires.
men separately, we age-standardized the prevalence
There were two exceptions to the above-mentioned
estimates for each regional cluster.
data-collection strategy. In Japan, a mailed, self-
A number of possible correlates of sexual pro-
completed questionnaire was used, and in Mexico, a
blems were investigated. These included age, self-
mixed-mode method of in-person and telephone
reported measures of general health status, current
interviews was employed. The mean overall re-
level of physical activity, self-report of a diagnosed
sponse rate was 19%, with the mean rate for the
vascular condition (including hypertension, dia-
telephone interviews at 15% and 30% for the self-
betes, heart disease, high cholesterol, and having
completed questionnaires and 33% for the mailed,
had a stroke), self-report of a diagnosis of depres-
self-completed questionnaires used in Japan. Re-
sion, prostate disease (among men), having had a
sponse rate ranged from 8–55% in the various
hysterectomy (among women), and whether respon-
countries.
dents currently or formerly smoked. Respondents
Verbal consent was obtained from all study
also reported how often they thought about sex—a
participants. They were also informed about the
proxy for their current level of sexual libido—and
following issues: (1) all information obtained would
whether they agreed with the belief that aging
be used in aggregate, (2) responses were voluntary,
reduced sexual desire and/or behavior. Other self-
(3) the confidentiality and the privacy of their
reported measures included educational attainment,
responses were protected because no personal
whether respondents believed that their religion
identifiers were coded into the interview instru-
guided their sexual behavior, experience with
ments, (4) no list of respondents was retained, and
divorce and financial problems in the 3-y period
International Journal of Impotence Research

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Risk factors for sexual problems
EO Laumann et al
41
prior to being interviewed, the expected time
were East Asia and Southeast Asia, where the
horizon of their current relationships, the frequency
prevalence of both complaints was approximately
of engaging in sex, whether they usually engaged in
double that reported in other regions.
foreplay, and whether they were sexually exclusive.
We utilized logistic regression in this study. This
approach produced adjusted odds ratios (ORs),
which indicate the odds of reporting the particular
Factors associated with the likelihood of reporting
sexual problem among those with a given character-
sexual problems
istic (eg poor health) relative to people in a reference
category (eg good health), controlling for all other
We analyzed the factors associated with the like-
factors in the regression analysis. In these analyses,
lihood of reporting sexual problems among women
the presence of a sexual problem included only
and men. We focused on more severe problems: only
those respondents who reported ‘sometimes’ or
those respondents indicating a periodic (sometimes)
‘frequently’ having the problem (ie those who
or frequent sexual problem in the 12 months prior to
indicated ‘occasionally’ were recoded to indicate
being interviewed were coded as having that
no sexual problem). In order to evaluate the validity
particular problem. Here we present detailed ana-
of pooling a specific country with the others in a
lyses of four selected problems: the inability to reach
regional cluster, we employed a series of interaction
orgasm and lubrication difficulties for women; early
models between covariates and country dummy
ejaculation and erectile difficulties among men.
variables to test whether a specific country could
be pooled in an analysis. Countries with covariate
patterns that were significantly different from the
pooled sample were dropped from the analysis
Women’s inability to reach orgasm
(results are available upon request). Thus, we
dropped the following countries: (1) Austria, the
UK, France, Italy, South Africa, Algeria, Taiwan,
Table 2 presents logistic-regression results for
Indonesia, Philippines, and Singapore in logistic
factors associated with the likelihood of reporting
regressions of orgasm problems; (2) Sweden, Israel,
an inability to reach orgasm among women. Age
Mexico, Egypt, Taiwan, and Philippines in logistic
does not appear to be systematically associated with
regressions of lubrication difficulties, (3) Morocco,
this problem, although several regions show some
Korea, Malaysia, Philippines, and Singapore in
positive associations. Poor health tends to increase
logistic regressions of early ejaculation; and (4) the
the likelihood of orgasm difficulties, but is only
UK, South Africa, Algeria, Morocco, Korea, Malay-
statistically significant in the non-European West
sia, and Thailand in logistic regressions of erectile
(OR ¼ 1.6) and East Asian (OR ¼ 1.5) populations. In
difficulties.
contrast, thinking about sex is associated with a
decreased likelihood of this problem.
Most other factors, including physical inactivity,
vascular diseases, having had a hysterectomy,
Results
smoking, and beliefs about aging and sexual energy
show inconsistent associations. Financial problems
and depression consistently show positive associa-
Prevalence of sexual problems among women
tions, however, few of the odds ratios reach
and men
statistical significance. Relationship characteristics
such as partnership status, the frequency of sex, and
Tables 1a and b present the prevalence of sexual
foreplay are generally nonsignificant, although
problems of 2 months or more duration, subdivided
women who have low expectations about the future
by frequency of occurrence, among women and men,
viability of their relationship(s) are consistently
respectively. In most cases, the reported prevalence
more likely to report this problem.
of sexual problems was higher in East Asia and
Southeast Asia than in other regions of the world.
For women, lack of interest in sex and inability to
Women’s lubrication difficulties
reach orgasm were the most common sexual pro-
blems across the world regions, ranging from 26 to
43% and 18 to 41%, respectively. For men, early
Table 3 presents logistic-regression results for
ejaculation was the most common complaint, with
factors associated with the likelihood of reporting
31% of men interviewed in Southeast Asia reporting
lubrication difficulties. Increasing age shows a
this problem. Finally, erectile difficulties among
curvilinear association with the likelihood of report-
men and lubrication difficulties among women were
ing this problem in all the world regions except for
both relatively common and showed similar pre-
Southeast Asia and South America. Women aged
valence across most regions. Notable exceptions
50–59 y in comparison with those aged 40–49 y are
International Journal of Impotence Research

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International
42
Journal
Table 1a
Prevalence of women’s sexual problems by region and severity
of
Impotence
Lack of sexual interest
Inability to reach orgasm
Orgasm too quickly
Pain during sex
Sex not pleasurable
Lubrication difficulties
Resea
Northern Europea
25.6 (23.4,27.8)
17.7 (15.7,19.6)
7.7 (6.3,9.1)
9.0(7.5,10.4)
17.1 (15.2,19.1)
18.4 (16.5,20.4)
Occasionally
8.9 (7.4,10.3)
7.3 (5.9,8.6)
3.8 (2.8,4.7)
3.5 (2.6,4.4)
7.4 (6.1,8.7)
5.8 (4.6,7.0)
rch
Periodically
11.4 (9.7,13.0)
6.9 (5.6,8.2)
3.0 (2.1,3.9)
3.5 (2.5,4.5)
7.1 (5.7,8.5)
6.8 (5.6,8.1)
Frequently
5.4 (4.2,6.5)
3.5 (2.5,4.5)
0.9 (0.5,1.3)
2.0 (1.3,2.7)
2.6 (1.8,3.4)
5.8 (4.6,7.0)
Southern Europeb
29.6 (27.3,31.9)
24.2 (22.0,26.4)
11.5 (9.9,13.0)
11.9 (10.3,13.4)
22.1 (20.0,24.2)
16.1 (14.2,17.9)
Occasionally
8.7 (7.4,10.0)
7.4 (6.1,8.6)
4.3 (3.3,5.4)
3.4 (2.6,4.2)
6.9 (5.7,8.1)
3.9 (3.0,4.8)
Periodically
13.1 (11.4,14.8)
11.1 (9.5,12.7)
5.5 (4.4,6.7)
5.4 (4.3,6.5)
11.2 (9.6,12.8)
7.5 (6.1,8.8)
Frequently
7.9 (6.4,9.3)
5.7 (4.5,6.9)
1.6 (1.0,2.2)
3.1 (2.2,4.0)
3.9 (2.9,5.0)
4.7 (3.6,5.8)
Non-European Westc
32.9 (30.5,35.4)
25.2 (22.9,27.5)
10.5 (9.1,12.0)
14.0 (12.3,15.8)
21.5 (19.3,23.7)
27.1 (24.8,29.4)
Risk
Occasionally
13.4 (11.6,15.2)
9.5 (7.9,11.1)
4.4 (3.5,5.4)
5.9 (4.7,7.2)
9.0 (7.7,11.0)
8.4 (7.0,9.8)
Periodically
12.6 (10.9,14.3)
10.4 (8.8,12.0)
4.8 (3.7,5.8)
5.3 (4.2,6.4)
8.5 (7.1,10.0)
10.9 (9.2,12.6)
factors
Frequently
7.0 (5.7,8.2)
5.3 (4.2,6.4)
1.4 (0.8,1.9)
2.8 (2.0,3.6)
3.7 (2.7,4.6)
7.8 (6.4,9.3)
for
Central/South Americad
28.1 (24.1,32.2)
22.4 (18.7,26.1)
18.3 (14.9,21.8)
16.6 (13.4,19.8)
19.5 (16.1,22.9)
22.5 (18.8,26.3)
EO
sexual
Occasionally
7.8 (5.4,10.5)
6.7 (4.5,8.9)
5.0 (3.1,6.8)
2.6 (1.4,3.9)
5.6 (3.5,7.7)
4.3 (2.4,6.2)
Laumann
Periodically
12.8 (9.8,15.8)
12.1 (9.2,14.9)
9.6 (6.8,12.3)
8.4 (6.1,10.6)
8.8 (6.5,11.1)
11.7 (8.9,14.5)
problems
Frequently
7.4 (5.0,9.8)
3.7 (2.0,5.3)
3.8 (2.3,5.4)
5.6 (3.4,7.9)
5.2 (3.3,7.0)
6.5 (4.3,8.7)
et
Middle Easte
43.4 (38.6,48.3)
23.0 (18.4,27.7)
10.0 (6.9,13.1)
21.0 (16.2,25.8)
31.0 (26.1,36.0)
23.0 (18.1,27.8)
al
Occasionally
14.3 (11.0,17.6)
6.1 (4.7,7.6)
3.8 (2.7,5.0)
6.6 (5.1,8.1)
9.2 (6.1,12.3)
10.7 (6.8,14.6)
Periodically
18.3 (13.7,22.8)
10.9 (7.7,14.0)
5.2 (2.3,8.0)
9.0 (5.2,12.8)
13.6 (10.4,16.9)
7.0 (5.4,8.5)
Frequently
10.9 (6.6,15.2)
6.0 (2.4,9.7)
1.0 (0.5,1.6)
5.4 (1.7,9.0)
8.2 (4.4,12.0)
5.3 (1.7,9.0)
East Asiaf
34.8 (32.0,37.7)
32.3 (29.5,35.1)
17.6 (15.2,20.0)
31.6 (28.8,34.4)
29.7 (26.9,32.4)
37.9 (35.0,40.7)
Occasionally
7.4 (5.8,9.0)
9.0 (7.4,10.7)
6.2 (4.7,7.7)
11.2 (9.3,13.0)
8.6 (6.9,10.2)
10.1 (8.4,11.8)
Periodically
13.8 (11.8,15.9)
11.9 (10.0,13.9)
7.0 (5.4,8.6)
11.8 (9.8,13.9)
10.4 (8.6,12.1)
15.6 (13.4,17.9)
Frequently
13.6 (11.4,15.9)
11.3 (9.3,13.3)
4.3 (3.0,5.6)
8.6 (6.7,10.5)
10.7 (8.7,12.8)
12.1 (9.9,14.3)
Southeast Asiag
43.3 (38.1,48.6)
41.2 (36.0,46.4)
26.3 (21.4,31.2)
29.2 (24.1,34.3)
35.9 (31.0,40.7)
34.2 (28.9,39.5)
Occasionally
9.5 (5.6,13.4)
7.3 (4.4,10.3)
6.6 (3.0,10.3)
6.7 (3.3,10.1)
8.2 (4.7,11.7)
6.5 (3.6,9.4)
Periodically
23.7 (19.1,28.4)
26.8 (21.7,31.9)
17.7 (13.3,22.1)
19.8 (14.9,24.6)
22.9 (18.2,27.7)
20.7 (16.1,25.2)
Frequently
10.1 (6.3,13.9)
7.1 (4.1,10.2)
2.0 (0.0,4.3)
2.7 (1.3,4.1)
4.7 (2.8,6.7)
7.1 (3.6,10.6)
Based on reports from sexually active respondents. 95% CI in parentheses. Percentage in the first row of each region panel indicates the regional average of sexual dysfunction,
defined as an experience of dysfunction for a period of 2 months or more. The difference between the regional average and the sum of the three levels of severity of sexual
dysfunction indicates the proportion who failed to specify the level of severity. All prevalences are adjusted according to the age distribution of the total of sexually active women in
the GSSAB survey.
aIncludes Austria, Belgium, Germany, Sweden, and the UK (n ¼ 1741).
bIncludes France, Israel, Italy, and Spain (n ¼ 1753).
cIncludes Australia, Canada, New Zealand, South Africa, and the US (n ¼ 1845).
dIncludes Brazil and Mexico (n ¼ 588).
eIncludes Algeria, Egypt, Morocco, and Turkey (n ¼ 967).
fIncludes China, Hong Kong, Japan, Korea, and Taiwan (n ¼ 1417).
gIncludes Indonesia, Malaysia, Philippines, Singapore, and Thailand (n ¼ 689).

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Table 1b
Prevalence of men’s sexual problems by region and severity
Lack of sexual interest
Inability to reach orgasm
Early ejaculation
Pain during sex
Sex not pleasurable
Erectile difficulties
Northern Europea
12.5 (11.1,13.9)
9.1 (7.9,10.4)
20.7 (19.0,22.5)
2.9 (2.2,3.6)
7.7 (6.5,8.8)
13.3 (11.8,14.7)
Occasionally
5.6 (4.6,6.6)
3.9 (3.1,4.8)
10.3 (9.0,11.6)
1.4 (0.9,1.9)
3.2 (2.5,4.0)
5.1 (4.1,6.0)
Periodically
4.4 (3.5,5.3)
3.6 (2.8,4.5)
7.3 (6.2,8.4)
1.2 (0.7,1.6)
2.6 (1.9,3.3)
5.5 (4.5,6.5)
Frequently
2.5 (1.9,3.2)
1.6 (1.0,2.1)
3.2 (2.5,4.0)
0.3 (0.1,0.6)
1.8 (1.2,2.4)
2.7 (2.0,3.4)
Southern Europeb
13.0 (11.6,14.5)
12.2 (10.8,13.6)
21.5 (19.8,23.3)
4.4 (3.6,5.3)
9.1 (7.9,10.3)
12.9 (11.5,14.3)
Occasionally
6.6 (5.6,7.7)
5.4 (4.4,6.3)
8.3 (7.1,9.4)
2.0 (1.4,2.6)
4.0 (3.2,4.8)
4.9 (3.9,5.8)
Periodically
5.1 (4.1,6.0)
5.2 (4.2,6.1)
10.1 (8.8,11.4)
1.8 (1.3,2.4)
3.7 (2.9,4.5)
6.1 (5.1,7.1)
Frequently
1.3 (0.9,1.8)
1.6 (1.1,2.2)
3.2 (2.4,3.9)
0.5 (0.2,0.8)
1.4 (0.9,1.9)
1.9 (1.3,2.5)
Non-European Westc
17.6 (15.9,19.2)
14.5 (13.0,16.1)
27.4 (25.4,29.3)
3.6 (2.8,4.4)
12.1 (10.7,13.5)
20.6 (18.8,22.4)
Occasionally
8.0 (6.8,9.1)
6.4 (5.3,7.5)
11.6 (10.3,13.0)
1.9 (1.3,2.5)
5.8 (4.8,6.8)
9.4 (8.1,10.7)
Periodically
6.8 (5.8,7.9)
5.4 (4.4,6.4)
11.0 (9.7,12.4)
1.0 (0.6,1.4)
3.8 (3.0,4.6)
6.7 (5.5,7.8)
Frequently
2.7 (2.0,3.5)
2.7 (2.0,3.5)
4.7 (3.8,5.6)
0.7 (0.3,1.1)
2.5 (1.8,3.2)
4.5 (3.6,5.5)
Central/South Americad
12.6 (9.9,15.2)
13.6 (10.9,16.3)
28.3 (24.8,31.8)
4.7 (3.0,6.3)
9.0 (6.7,11.2)
13.7 (11.0,16.4)
Occasionally
3.7 (2.2,5.2)
5.1 (3.3,6.8)
6.4 (4.5,8.3)
1.2 (0.4,2.1)
4.5 (2.9,6.1)
5.0 (3.3,6.7)
Periodically
6.9 (4.9,8.9)
6.7 (4.7,8.7)
13.6 (10.9,16.3)
2.3 (1.1,3.5)
3.0 (1.7,4.3)
6.3 (4.3,8.2)
Frequently
2.0 (0.9,3.1)
1.9 (0.8,3.0)
8.3 (6.1,10.4)
1.1 (0.3,1.9)
1.5 (0.5,2.5)
2.4 (1.2,3.7)
Middle Easte
21.6 (19.1,24.0)
13.2 (11.1,15.3)
12.4 (10.5,14.2)
10.2 (8.3,12.0)
14.3 (12.1,16.4)
14.1 (11.9,16.2)
Occasionally
8.8 (7.1,10.4)
5.6 (4.2,7.0)
3.8 (2.8,4.8)
3.1 (2.0,4.2)
6.1 (4.7,7.5)
5.7 (4.2,7.2)
Periodically
9.7 (7.8,11.6)
6.4 (4.8,8.0)
6.1 (4.7,7.5)
6.1 (4.6,7.5)
7.2 (5.6,8.8)
7.4 (5.6,9.1)
EO
Risk
Frequently
3.1 (1.8,4.3)
1.1(0.4,1.9)
2.5 (1.6,3.3)
1.3 (0.3,1.7)
1.0 (0.3,1.7)
1.0 (0.3,1.7)
Laumann
factors
East Asiaf
19.6 (17.7,21.5)
17.2 (15.4,18.9)
29.1 (26.9,31.2)
5.8 (4.7,7.0)
12.2 (10.7,13.8)
27.1 (25.1,29.2)
for
Occasionally
7.4 (6.2,8.7)
6.6 (5.4,7.8)
9.6 (8.2,11.1)
3.0 (2.1,3.8)
5.2 (4.1,6.2)
11.9 (10.3,13.4)
et
Periodically
9.1 (7.8,10.5)
7.7 (6.4,9.0)
13.8 (12.2,15.5)
2.0 (1.3,2.6)
5.0 (4.0,6.1)
10.8 (9.3,12.3)
al
sexual
Frequently
3.0 (2.2,3.9)
2.8 (2.0,3.7)
5.6 (4.5,6.7)
0.9 (0.4,1.4)
2.0 (1.3,2.7)
4.5 (3.4,5.5)
problems
Southeast Asiag
28.0 (24.5,31.5)
21.1 (17.8,24.4)
30.5 (27.0,34.1)
12.0 (9.4,14.7)
17.4 (14.3,20.4)
28.1 (24.6,31.6)
Occasionally
7.7 (5.3,10.1)
5.7 (3.8,7.7)
5.3 (3.7,6.9)
4.0 (2.4,5.7)
5.0 (3.3,6.8)
6.3 (4.3,8.4)
Periodically
17.4 (14.5,20.2)
13.3 (10.4,16.1)
19.8 (16.6,23.1)
7.2 (5.0,9.4)
10.4 (7.9,12.9)
16.6 (13.5,19.7)
Frequently
2.9 (1.4,4.5)
2.1 (0.7,3.5)
5.4 (3.2,7.5)
0.8 (0.2,1.4)
2.0 (0.8,3.1)
5.2 (3.4,7.0)
Based on reports from sexually active respondents. 95% CI in parentheses. Percentage in the first row of each region panel indicates the regional average of sexual dysfunction,
defined as an experience of dysfunction for a period of 2 months or more. The difference between the regional average and the sum of the three levels of severity of sexual
dysfunction indicates the proportion who failed to specify the level of severity. All prevalences are adjusted according to the age distribution of the total of sexually active men in the
GSSAB survey.
a
International
Includes Austria, Belgium, Germany, Sweden, and the UK (n ¼ 2151).
bIncludes France, Israel, Italy, and Spain (n ¼ 2160).
cIncludes Australia, Canada, New Zealand, South Africa, and the US (n ¼ 2205).
d
Journal
Includes Brazil and Mexico (n ¼ 639).
eIncludes Algeria, Egypt, Morocco, and Turkey (n ¼ 1349).
f
of
Includes China, Hong Kong, Japan, Korea, and Taiwan (n ¼ 1731).
Impot
gIncludes Indonesia, Malaysia, Philippines, Singapore, and Thailand (n ¼ 970).
ence
Research
43

---

Risk factors for sexual problems
EO Laumann et al
44
Table 2 Factors associated with women’s inability to reach orgasm by region
N. Europe
S. Europe
Non-E. West C/S. America
Middle East
East Asia
SE Asia
Age (y)
40–49
Referent
Referent
Referent
Referent
Referent
Referent
Referent
50–59
1.4 (0.7,2.5)
1.3 (0.8,2.3) 1.6* (1.1,2.4)
0.7 (0.4,1.3)
2.7* (1.5,5.0)
1.1 (0.8,1.7)
1.4 (0.5,3.4)
w
60–69
2.2* (1.1,4.4)
1.0 (0.5,1.9)
1.1 (0.7,1.9)
1.3 (0.6,2.9)
2.8* (1.4,5.7)
1.1 (0.7,1.8) 3.1 (0.9,10.7)
w
70–80
2.2 (0.8,6.3)
1.2 (0.5,2.8)
1.0 (0.4,2.5) 0.3 (0.1,1.2)
3.9 (0.8,20.3)
0.8 (0.4,1.7)
n.a.
w
Fair/Poor overall health
1 (0.6,1.8)
1.3 (0.8,2.1) 1.6* (1.0,2.6)
0.9 (0.5,1.6)
1.4 (0.7,2.6)
1.5* (1.1,2.1) 2.0 (0.9,4.3)
(vs good)
Level of physical activity
Average and above
Referent
Referent
Referent
Referent
Referent
Referent
Referent
Lower than average
1.9* (1.1,3.4)
0.6 (0.3,1.4)
1.2 (0.7,1.8) 0.4* (0.1,1.0)
1.8 (0.8,3.8)
0.9 (0.6,1.4) 2.2* (1.0,4.6)
w
Vascular diseases
0.7 (0.4,1.3)
1.6* (1.0,2.6)
1.0 (0.7,1.5) 1.7 (1.0,3.0)
0.8 (0.4,1.3)
1.1 (0.8,1.6)
1.0 (0.3,2.9)
Hysterectomy
1.2 (0.6,2.3)
1.0 (0.5,2.2)
0.8 (0.5,1.2)
0.8 (0.4,1.5)
1.1 (0.5,2.6)
1.0 (0.6,1.9) 0.4* (0.2,1.0)
Smoking
Never
Referent
Referent
Referent
Referent
Referent
Referent
Referent
Smoked before
1.1 (0.6,1.9)
1.4 (0.7,2.8)
1.3 (0.8,1.9)
1.1 (0.6,2.1)
1.7 (0.8,3.5)
0.6 (0.3,1.2)
1.7 (0.3,9.4)
Currently smoking
0.8 (0.4,1.6)
0.9 (0.5,1.6) 1.9* (1.2,3.0)
1.1 (0.5,2.0)
2.0* (1.1,3.6)
1.0 (0.6,1.8)
0.6 (0.2,2.1)
Thinking of sex
Never or o1/month
Referent
Referent
Referent
Referent
Referent
Referent
Referent
A few times/month
1.2 (0.4,3.3)
0.8 (0.5,1.4)
0.7 (0.4,1.2)
0.8 (0.4,1.6)
0.6 (0.3,1.1)
0.6* (0.4,0.9)
0.6 (0.2,1.5)
A few times/week
0.9 (0.2,4.0)
0.9 (0.3,2.9) 0.4* (0.2,0.8)
0.5 (0.1,1.8)
0.6 (0.2,2.4)
n.a.
0.2 (0.0,4.1)
w
Belief that aging reduces
1.4 (0.8,2.4)
1.3 (0.8,2.0) 1.6* (1.0,2.4)
0.9 (0.5,1.5)
0.8 (0.5,1.4)
1.3 (1.0,1.8)
0.6 (0.3,1.5)
sex energy
Education
At least some college
Referent
Referent
Referent
Referent
Referent
Referent
Referent
Secondary/high school
0.5* (0.3,1.0)
0.8 (0.4,1.7)
0.8 (0.6,1.2)
1.6 (0.7,3.6)
1.1 (0.5,2.2)
1.3 (0.9,2.0)
0.7 (0.3,1.8)
Primary school or less
1.4 (0.7,2.8)
1.1 (0.5,2.4)
0.8 (0.3,2.3)
1.8 (0.8,3.9)
1.7 (0.6,2.7)
1.2 (0.7,2.2) 0.3* (0.1,0.9)
Belief in religion guiding sex
2.3* (1.2,4.2)
1.1 (0.7,1.8)
1.2 (0.8,1.7)
1.6 (0.9,2.7)
1.0 (0.6,1.8)
1.2 (0.7,2.1)
1.9 (0.8,4.4)
Divorce in past 3 y
0.3 (0.0,2.1)
1.6 (0.4,6.1)
0.5 (0.2,1.3)
1.4 (0.2,13.0)
1.7 (0.6,5.2)
0.7 (0.1,3.7)
1.2 (0.3,4.9)
Financial problems in last 3 y
1.2 (0.5,2.6)
1.5 (0.8,2.8) 1.8* (1.2,2.8)
1.1 (0.6,1.9)
1.1 (0.6,2.0)
0.7 (0.4,1.2) 2.8* (1.2,6.2)
w
w
Depression diagnosed
1.6 (0.8,3.4)
1.6* (1.0,2.6)
1.4 (0.9,2.1) 1.7 (1.0,3.1)
1.3 (0.7,2.3)
1.2 (0.6,2.5) 2.7 (0.8,8.7)
Partnership status
Exclusive and committed
Referent
Referent
Referent
Referent
Referent
Referent
Referent
w
Exclusive but not committed
1.0 (0.4,2.6)
0.9 (0.3,2.9)
1.4 (0.8,2.4) 0.3 (0.1,1.1)
0.2 (0.0,1.8)
0.4 (0.1,1.6) 0.1* (0.0,0.7)
w
Non-exclusive
0.5 (0.1,4.1)
0.4 (0.0,2.9)
1.4 (0.3,5.8)
0.4 (0.1,1.8)
0.3 (0.1,1.2)
1.3 (0.6,3.0)
0.6 (0.1,2.7)
Future of the relationship
High hope
Referent
Referent
Referent
Referent
Referent
Referent
Referent
w
w
Worried
1.0 (0.3,3.1)
1.3 (0.5,3.8) 3.7* (2.0,6.7) 2.2 (1.0,5.0)
1.3 (0.5,3.8)
1.7 (1.0,2.8)
1.1 (0.3,3.3)
w
No future
2.9 (0.8,10.0)
0.7 (0.4,1.4)
2.0 (0.8,4.8) 2.4* (1.0,5.4)
2.9 (0.8,8.7)
2.9* (1.5,5.5)
0.3 (0.1,2.1)
Frequency of sexual relationship
Several times per week
Referent
Referent
Referent
Referent
Referent
Referent
Referent
2 to 3 times per month
1.3 (0.8,2.3)
0.8 (0.5,1.3)
1.2 (0.8,1.8)
1.0 (0.5,1.7)
1.1 (0.6,1.9)
1.4 (0.8,2.2)
0.8 (0.3,2.1)
Less than monthly
2.3* (1.1,4.8)
1.1 (0.6,2.1)
1.0 (0.6,1.7)
1.1 (0.4,2.8)
1.2 (0.4,3.1)
1.3 (0.7,2.3)
0.8 (0.2,3.0)
Usually does not engage
0.9 (0.4,1.9)
0.9 (0.5,1.6)
1.6 (0.9,2.8) 2.1* (1.2,3.8)
0.8 (0.4,1.5)
1.6* (1.1,2.3)
1.3 (0.5,3.8)
in foreplay
w2
80.1
40.2
122.3
46.2
78.0
96.4
42.7
d.f.
27
26
28
26
27
27
25
Observations
1043
602
1338
531
749
1159
235
Odds ratios from logistic regression. Based on reports from sexually active women. Country differences in each region controlled.
Northern Europe includes Belgium, Sweden, and Germany.
Southern Europe includes Spain and Israel.
Non-European West includes Australia, Canada, New Zealand, and the US.
Central/South America includes Brazil and Mexico.
Middle East includes Egypt, Morocco, and Turkey.
East Asia includes China, Hong Kong, Korea, and Japan.
Southeast Asia includes Malaysia, and Thailand.
w
*Pr0.05; Pr0.10.
International Journal of Impotence Research

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Risk factors for sexual problems
EO Laumann et al
45
Table 3 Factors associated with women’s lubrication difficulties by region
N. Europe
S. Europe
Non-E. West C/S. America
Middle East
East Asia
SE Asia
Age (y)
40–49
Referent
Referent
Referent
Referent
Referent
Referent
Referent
50–59
2.1* (1.2,3.5) 1.9* (1.2,3.1) 1.7* (1.2,2.3)
1.0 (0.5,1.9) 2.6* (1.3,5.0)
2.2* (1.5,3.3)
0.7 (0.4,1.3)
60–69
2.8* (1.6,5.0) 2.8* (1.7,4.7) 1.6* (1.0,2.5)
1.6 (0.7,4.0) 3.2* (1.4,6.9)
3.3* (2.0,5.3)
0.9 (0.4,2.1)
w
w
70–80
1.7 (0.6,4.7) 2.0 (0.9,4.6)
1.2 (0.6,2.5)
0.6 (0.1,2.8)
4.6 (0.9,23.4) 3.0* (1.4,6.5)
n.a.
w
Poor overall health (vs good)
1.6* (1.0,2.6)
1.3 (0.9,2.0)
1.3 (0.9,1.9)
0.7 (0.3,1.2)
1.7 (0.9,3.2)
1.5* (1.1,2.0)
1.4 (0.8,2.5)
Level of physical activity
Average and above
Referent
Referent
Referent
Referent
Referent
Referent
Referent
Lower than average
0.8 (0.5,1.4)
1.0 (0.6,1.6)
1.0 (0.7,1.5)
0.9 (0.4,2.1)
1.7 (0.9,3.6)
1.1 (0.7,1.7) 2.0* (1.2,3.3)
w
Vascular diseases
1.0 (0.6,1.4) 0.7 (0.5,1.1)
1.1 (0.8,1.4)
1.0 (0.6,1.8) 0.5* (0.3,0.9)
0.9 (0.6,1.3)
0.9 (0.5,1.7)
Hysterectomy
1.3 (0.8,2.1) 0.5* (0.3,0.8) 0.7* (0.5,1.0)
1.1 (0.5,2.1)
0.8 (0.3,2.1)
1.2 (0.6,2.2)
0.8 (0.3,1.9)
Smoking
Never
Referent
Referent
Referent
Referent
Referent
Referent
Referent
Smoked before
1.5 (0.9,2.4)
1.4 (0.8,2.3)
0.9 (0.6,1.3)
1.0 (0.5,1.9) 2.5* (1.1,5.5)
0.6 (0.3,1.2)
1.2 (0.4,3.8)
Currently smoking
1.1 (0.7,1.8)
1.0 (0.6,1.5)
1.1 (0.8,1.7)
0.6 (0.3,1.4)
1.5 (0.7,3.1)
1.3 (0.7,2.4)
1.3 (0.6,3.0)
Thinking of sex
Never or o1/month
Referent
Referent
Referent
Referent
Referent
Referent
Referent
w
A few times/month
0.4* (0.2,0.7) 0.7 (0.4,1.1) 0.5* (0.3,0.8)
1.2 (0.5,2.9)
0.7 (0.4,1.4)
0.9 (0.6,1.3)
0.8 (0.4,1.4)
A few times/week
0.6 (0.3,1.2)
0.9 (0.3,2.4) 0.4* (0.2,0.8)
0.5 (0.1,1.9)
0.7 (0.2,2.8)
0.7 (0.1,4.7)
0.5 (0.1,2.2)
Belief that aging reduces
1.2 (0.8,1.8) 1.6* (1.1,2.3)
1.2 (0.9,1.8)
1.1 (0.6,1.9)
1.0 (0.6,1.8)
1.4* (1.0,2.0)
1.3 (0.8,2.1)
sex energy
Education
At least some college
Referent
Referent
Referent
Referent
Referent
Referent
Referent
w
Secondary/high school
0.6 (0.4,1.0)
0.8 (0.5,1.4) 0.7* (0.5,1.0)
1.1 (0.5,2.3)
0.6 (0.2,1.5)
1.0 (0.7,1.6)
0.7 (0.4,1.1)
w
Primary school or less
0.4* (0.2,0.9)
1.2 (0.7,2.1)
0.7 (0.3,1.5)
0.8 (0.4,1.7)
0.5 (0.3,1.1)
1.0 (0.6,1.8) 0.5* (0.2,1.0)
w
w
Belief in religion guiding sex
1.2 (0.7,1.9) 0.6* (0.4,0.9) 1.3 (1.0,1.8)
1.6 (0.9,2.9)
1.4 (0.8,2.7)
1.7* (1.0,2.9) 1.7 (0.9,2.9)
Divorce in past 3 y
n.a.
2.2 (0.6,8.0)
0.5 (0.2,1.2)
n.a.
n.a.
1.2 (0.2,6.8)
2.1 (0.7,6.2)
w
Financial problems in last 3 y
0.4 (0.1,1.0)
1.0 (0.6,1.7)
0.9 (0.6,1.3)
1.1 (0.6,2.0)
1.4 (0.6,3.0)
1.2 (0.8,2.0) 2.0* (1.2,3.5)
w
Depression diagnosed
1.4 (0.8,2.6) 1.8* (1.2,2.6) 1.8* (1.2,2.6) 1.8 (1.0,3.4)
1.6 (0.8,3.3)
1.2 (0.5,2.7)
1.6 (0.7,3.6)
Partnership status
Exclusive and committed
Referent
Referent
Referent
Referent
Referent
Referent
Referent
w
Exclusive but not committed
1.0 (0.5,2.1)
0.9 (0.4,2.0)
1.1 (0.7,1.7) 0.3 (0.1,1.0)
0.7 (0.1,4.0)
0.3 (0.1,1.4)
0.9 (0.2,4.0)
Nonexclusive
0.3 (0.0,2.3)
0.4 (0.1,1.6)
0.9 (0.3,2.8)
0.4 (0.1,1.8)
2.0 (0.5,8.6)
1.0 (0.4,2.5)
1.1 (0.4,3.1)
Future of the relationship
High hope
Referent
Referent
Referent
Referent
Referent
Referent
Referent
Worried
2.6* (1.0,6.8)
1.0 (0.4,2.6) 2.3* (1.4,3.8)
1.9 (0.8,4.4)
1.2 (0.4,3.5)
1.0 (0.5,1.8)
1.0 (0.4,2.7)
No future
0.6 (0.2,2.5)
1.2 (0.6,2.4)
1.2 (0.5,3.1)
1.7 (0.6,4.8)
1.0 (0.2,4.9)
1.6 (0.8,3.1)
0.4 (0.1,3.1)
Frequency of sexual relationship
Several times per week
Referent
Referent
Referent
Referent
Referent
Referent
Referent
w
2 to 3 times per month
1.2 (0.8,1.9) 1.5 (1.0,2.2)
1.3 (0.9,1.7)
1.6 (0.9,2.9)
1.0 (0.5,1.9)
1.0 (0.6,1.6)
0.9 (0.5,1.6)
Less than monthly
1.4 (0.7,2.9)
1.2 (0.7,2.1)
1.2 (0.7,1.9)
1.3 (0.4,4.1)
1.6 (0.7,3.8)
1.2 (0.7,2.1)
0.7 (0.3,1.5)
Usually does not engage
1.1 (0.6,2.0)
1.1 (0.7,1.7)
0.8 (0.5,1.3)
1.1 (0.5,2.1)
1.1 (0.6,2.0)
1.4* (1.0,2.1)
0.9 (0.5,1.7)
in foreplay
w2
66.4
79.1
125.9
26.7
53.9
116.2
39.9
d.f.
27
27
29
24
26
28
27
Observations
1053
1477
1557
374
694
1167
548
Odds ratios from logistic regression. Based on reports from sexually active women. Country differences in each region controlled.
Northern Europe includes Belgium, Sweden, and Germany.
Southern Europe includes Spain and Israel.
Non-European West includes Australia, Canada, New Zealand, and the US.
Central/South America includes Brazil and Mexico.
Middle East includes Egypt, Morocco, and Turkey.
East Asia includes China, Hong Kong, Korea, and Japan.
Southeast Asia includes Malaysia, and Thailand.
w
*Pr0.05; Pr0.10.
International Journal of Impotence Research

---

Risk factors for sexual problems
EO Laumann et al
46
roughly twice as likely to report lubrication diffi-
and Southeast Asia, men aged 60–80 y are signifi-
culties across several regions, including Northern
cantly more likely to report erectile difficulties than
Europe (OR ¼ 2.1), Southern Europe (OR ¼ 1.9), the
those aged 40–49 y (OR from 2.7 to 6.9). Physical
non-European West (OR ¼ 1.7), East Asia (OR ¼ 2.2),
factors, such as a history of vascular conditions and
and the Middle East (OR ¼ 2.6). However, their
prostate disease, are also relevant. Having had a
counterparts, who are 70–80 y old, are no more
vascular condition increases the likelihood of
likely to report this problem than the youngest
erectile difficulties in almost all world regions, with
cohort in most regions of the world.
ORs ranging from 1.4 to 4.4. Prostate disease
Most physical status factors are not associated with
consistently increases the likelihood of erectile
lubrication difficulties, but having had a hysterect-
difficulties in all world regions as well, but is only
omy is consistently associated with a lower likelihood
statistically
significant
in
Northern
Europe
of this problem. With the exception of Southern
(OR ¼ 1.8) and Southern Europe (OR ¼ 2.0).
Europe, belief in religion guiding sex is associated
Regarding the remaining factors, financial pro-
with consistently raised odds ratios, although statis-
blems elevate the likelihood of erectile difficulties
tical significance is seen only in East Asia.
in several world regions, including Northern Europe
Women with lower educational attainment are
(OR ¼ 2.3), Southeast Asia (OR ¼ 2.2), and the Mid-
less likely to report problems with lubrication in
dle East (OR ¼ 3.1). Moreover, men with a history of
several world regions. Also, women who have been
depression are also more likely to report problems
diagnosed with depression in the past are greater
with erections, although these findings are statisti-
than one and one-half times more likely to report
cally significant only in Southern Europe (OR ¼ 1.9)
this problem in Southern European (OR ¼ 1.8), non-
and the non-European West (OR ¼ 1.9). Finally,
European Western (OR ¼ 1.8), Central/South Amer-
several relationship characteristics are relevant as
ican (OR ¼ 1.8), Middle Eastern (OR ¼ 1.6), and
well. Men in uncommitted relationships tend to
Southeast Asian (OR ¼ 1.6) country clusters.
experience these problems more, and erectile diffi-
culties appear to be highly associated with infre-
quent sex.
Men’s early ejaculation
Other sexual problems
Table 4 presents logistic-regression results for
factors associated with the likelihood of reporting
early ejaculation. Vascular diseases initially seemed
We also examined several additional sexual pro-
to be correlated with an increased probability of
blems using logistic regression, including a lack of
reporting early ejaculation; however, it appears that
interest in sex (Table 6), pain during sex (Table 7),
this association was confounded by ED, likely due to
and non-pleasurable sex (Table 8) among women
confusion about the two conditions in the respon-
and a lack of interest in sex (Table 9), the inability to
dents. After controlling for ED, early ejaculation was
orgasm (Table 10), and nonpleasurable sex (Table 11)
correlated with vascular diseases only in the Middle
among men.
East.
For women, a lack of interest in sex is associated
In general, education is negatively associated with
with the belief that aging reduces sexual desire and
this problem; men without a college education are
activity (OR from 1.2 to 1.8), thinking about sex
twice as likely to report this problem in Central/
infrequently (thinking about sex more frequently is
South America (OR ¼ 2.3–2.6) and the Middle East
associated with OR from 0.3 to 1.0), depression (OR
(OR ¼ 2.2–2.3). Experience with financial problems
from 1.3 to 2.2), low expectations about the future of
elevates the likelihood of reporting early ejaculation,
the relationship (lower expectations are associated
but this is statistically significant only in the Middle
with OR from 1.2 to 3.1 in all regions except
East (OR ¼ 1.8). Infrequent sex tends to be associated
Southeast Asia (OR ¼ 0.5)), and infrequent sex (less
with the likelihood of this problem. Overall, these
frequent sex is associated OR from 1.0 to 3.1, within
models had the least explanatory power in this
all regions except East Asia (OR ¼ 0.9)) (Table 6).
study.
Factors associated with pain during sex among
women include younger age (the effect shows
considerable variability between regions), poor
Men’s erectile difficulties
health (OR from 1.0 to 2.1), infrequent sex (OR from
1.0 to 2.6), and low expectations about the future of
the relationship (there is some variability between
Table 5 presents logistic-regression results for
regions, however, lower expectations were usually
factors associated with the likelihood of reporting
associated with increasing likelihood of the problem
erectile difficulties. Aging effects are quite strong
(Table 7)).
across most regions with respect to erectile difficul-
With respect to nonpleasurable sex among wo-
ties. In all regions, except Central/South America
men, thinking about sex infrequently (with thinking
International Journal of Impotence Research

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Risk factors for sexual problems
EO Laumann et al
47
Table 4 Factors associated with men’s early ejaculation by region
N. Europe
S. Europe
Non-E. West
C/S. America
Middle East
East Asia
SE Asia
Age (y)
40–49
Referent
Referent
Referent
Referent
Referent
Referent
Referent
w
w
50–59
0.8 (0.5,1.1)
1.4 (0.9,2.1) 0.7 (0.5,1.0)
0.5 (0.3,1.1)
0.9 (0.5,1.5)
1.2 (0.8,1.8)
0.7 (0.3,1.5)
60–69
0.7 (0.5,1.1) 1.7* (1.1,2.7)
0.9 (0.6,1.4)
0.8 (0.4,1.8)
1.0 (0.5,2.0)
0.9 (0.5,1.6)
0.5 (0.2,1.4)
w
w
70–80
0.5 (0.3,1.1)
1.4 (0.8,2.5) 0.6 (0.3,1.1)
0.5 (0.1,1.4)
0.5 (0.1,2.1)
0.9 (0.4,1.8)
0.7 (0.1,9.4)
Poor overall health
1.0 (0.7,1.5)
1.3 (0.9,1.7) 1.6* (1.1,2.3)
1.0 (0.6,1.9)
0.9 (0.5,1.6)
1.2 (0.8,1.8)
0.5 (0.2,1.4)
(vs good)
Level of physical activity
Average and above
Referent
Referent
Referent
Referent
Referent
Referent
Referent
Lower than average
0.8 (0.5,1.2)
0.9 (0.6,1.4)
0.7 (0.4,1.2)
1.3 (0.6,3.3)
0.6 (0.2,1.8)
0.9 (0.5,1.7)
0.9 (0.4,1.8)
Vascular diseases
1.2 (0.8,1.6)
1.1 (0.8,1.5)
0.9 (0.6,1.2)
1.2 (0.7,2.2)
2.0* (1.2,3.3)
1.3 (0.9,2.0)
1.4 (0.7,2.9)
Erectile difficulties
6.0* (3.8,9.4) 4.1* (2.6,6.3) 4.4* (2.8,6.7) 11.9* (4.9,28.6) 3.7* (1.6,8.8) 6.9* (4.3,10.9) 5.7* (2.5,13.2)
w
Prostate disease
0.6 (0.3,1.5) 1.7 (1.0,3.0)
0.8 (0.4,1.6)
1.34 (0.5,3.6)
0.4 (0.1,1.5)
1.7 (0.9,3.1)
2.4 (0.5,11.3)
Smoking
Never
Referent
Referent
Referent
Referent
Referent
Referent
Referent
Smoked before
0.9 (0.6,1.3)
1.0 (0.7,1.5)
1.1 (0.8,1.5)
0.9 (0.5,1.6)
0.8 (0.4,1.6) 1.8* (1.0,3.0)
0.9 (0.3,2.7)
w
w
Currently smoking
1.0 (0.7,1.5)
1.2 (0.8,1.7)
1.1 (0.7,1.5)
0.8 (0.4,1.7)
0.7 (0.4,1.4) 1.5 (0.9,2.5)
0.9 (0.4,2.1)
Thinking of sex
Never or o1/month
Referent
Referent
Referent
Referent
Referent
Referent
Referent
A few times/month
1.0 (0.3,2.8)
1.0 (0.5,1.8)
1.1 (0.5,2.4)
1.1 (0.3,4.5)
0.5 (0.2,1.4)
1.1 (0.6,2.0)
0.7 (0.3,2.2)
A few times/week
0.9 (0.3,2.6)
0.7 (0.3,1.4)
1.3 (0.6,2.8)
0.6 (0.1,2.8)
0.6 (0.2,1.7)
2.2 (0.8,6.4)
2.0 (0.4,10.2)
Belief that aging reduces
1.2 (0.9,1.7)
1.2 (0.9,1.6)
1.1 (0.7,1.6)
0.9 (0.6,1.5)
0.8 (0.5,1.3)
1.1 (0.8,1.6)
0.7 (0.4,1.4)
sex energy
Education
At least some college
Referent
Referent
Referent
Referent
Referent
Referent
Referent
Secondary/high school
1.4 (0.9,2.1)
1.2 (0.8,1.8)
1.2 (0.9,1.6)
2.6* (1.1,6.2)
2.2* (1.1,4.1)
0.9 (0.6,1.4)
1.6 (0.7,3.6)
w
Primary school or less
1.0 (0.6,1.8)
1.6 (1.0,2.4)
1.0 (0.6,1.7)
2.3 (0.9,5.6)
2.3* (1.3,4.3)
1.2 (0.6,2.2)
0.8 (0.3,2.6)
Belief in religion guiding sex
1.1 (0.7,1.7)
0.9 (0.7,1.3)
1.3 (0.9,1.7)
1.3 (0.7,2.3)
1.1 (0.7,1.8)
2.0 (0.9,4.2)
1.7 (0.7,3.8)
Divorce in past 3 y
1.2 (0.5,3.1)
0.6 (0.2,1.7)
1.7 (0.9,3.3)
4.9* (1.1,21.6)
0.7 (0.2,2.5)
0.5 (0.1,2.1)
1.7 (0.4,7.3)
w
w
Financial problems in last 3 y
1.2 (0.7,2.2) 1.5 (0.9,2.3)
1.2 (0.8,1.7)
1.4 (0.8,2.5)
1.8* (1.1,3.1)
1.1 (0.7,1.9)
2.0 (0.9,4.5)
Depression diagnosed
1.0 (0.6,1.9)
1.1 (0.7,1.7)
0.8 (0.5,1.3)
2.9* (1.2,7.2)
2.0 (0.8,4.6)
0.4 (0.1,1.9)
1.6 (0.6,4.7)
Partnership status
Exclusive and committed
Referent
Referent
Referent
Referent
Referent
Referent
Referent
Exclusive but not committed
0.9 (0.5,1.6)
0.8 (0.4,1.7)
1.0 (0.6,1.7)
0.9 (0.3,2.4)
n.a.
1.0 (0.2,3.9)
0.2 (0.0,2.7)
w
w
Non-exclusive
0.3 (0.1,1.1)
1.0 (0.5,1.8)
1.2 (0.7,2.3)
1.8 (0.8,4.1)
1.9* (1.0,3.4) 1.7 (0.9,3.3)
1.4 (0.5,3.6)
Future of the relationship
High hope
Referent
Referent
Referent
Referent
Referent
Referent
Referent
Worried
1.5 (0.8,2.7)
1.3 (0.6,2.7) 1.9* (1.1,3.3)
1.7 (0.7,4.4)
0.8 (0.1,8.1)
1.2 (0.5,2.7)
0.4 (0.1,1.5)
No future
0.8 (0.3,2.2)
1.0 (0.6,1.7)
0.7 (0.4,1.5)
0.3* (0.1,1.0)
1.3 (0.3,5.7)
2.2 (0.7,6.5)
n.a.
Frequency of sexual relationship
Several times per week
Referent
Referent
Referent
Referent
Referent
Referent
Referent
2 to 3 times per month
1.2 (0.9,1.7)
0.9 (0.7,1.2) 1.8* (1.3,2.4)
1.0 (0.5,1.8)
0.4* (0.2,0.8)
1.5 (0.9,2.6)
1.0 (0.5,2.3)
Less than monthly
1.2 (0.9,2.3)
0.8 (0.4,1.4) 2.0* (1.3,3.2)
0.5 (0.1,2.4)
0.4 (0.1,2.0) 2.1* (1.0,4.1)
2.4 (0.8,7.9)
Usually does not engage
1.0 (0.5,1.8)
0.9 (0.5,1.4) 1.8* (1.0,3.0)
1.1 (0.5,2.5)
1.4 (0.7,2.7)
0.7 (0.4,1.2)
1.4 (0.5,3.9)
in foreplay
w2
107.6
151.4
150.9
70.9
82.7
144.6
62.7
d.f.
30
29
30
27
27
29
26
Observations
1839
1879
1754
530
894
1101
404
Odds ratios from logistic regression—adjusted for presence of erectile difficulties. Based on reports from sexually active men. Country
differences in each region controlled.
Northern Europe includes Austria, Belgium, Sweden, the UK, and Germany.
Southern Europe includes France, Israel, Italy, and Spain.
Non-European West includes Australia, Canada, New Zealand, South Africa, and the US.
Central/South America includes Brazil and Mexico.
Middle East includes Algeria, Egypt and Turkey.
East Asia includes China, Hong Kong, Taiwan, and Japan.
Southeast Asia includes Indonesia and Thailand.
w
*Pr0.05; Pr0.10.
International Journal of Impotence Research

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Risk factors for sexual problems
EO Laumann et al
48
Table 5 Factors associated with men’s erectile difficulties by region
N. Europe
S. Europe
Non-E. West C/S. America
Middle East
East Asia
SE Asia
Age (y)
40–49
Referent
Referent
Referent
Referent
Referent
Referent
Referent
w
50–59
2.0 (1.0,4.1) 4.2* (2.1,8.5)
1.5 (0.9,2.4) 0.4* (0.1,1.0)
1.3 (0.4,4.4) 1.9* (1.0,3.7)
1.1 (0.5,2.1)
w
60–69
3.9* (1.9,8.1) 6.5* (3.2,13.3) 3.7* (2.2,6.3) 0.4 (0.1,1.2)
2.7 (0.7,10.4) 4.3* (2.3,8.3)
1.1 (0.5,2.3)
70–80
2.7* (1.0,7.1) 6.9* (3.1,15.4) 4.7* (2.5,9.0) 0.5 (0.1,2.1) 6.8* (1.4,34.5) 6.6* (3.2,13.6) 1.9 (0.5,6.5)
w
w
Poor overall health
1.4 (0.8,2.4) 1.8* (1.2,2.8)
1.5 (0.9,2.5) 2.0 (0.9,4.5)
0.6 (0.2,1.9)
1.1 (0.7,1.6)
1.8 (1.0,3.5)
(vs good)
Level of physical activity
Average and above
Referent
Referent
Referent
Referent
Referent
Referent
Referent
w
Lower than average
1.1 (0.6,1.9)
1.0 (0.6,1.7) 2.1* (1.2,3.6) 0.4 (0.1,1.4)
3.0 (0.8,11.4) 1.6 (0.9,3.0)
1.8 (0.8,3.9)
w
Vascular diseases
1.6* (1.0,2.7) 2.2* (1.5,3.4)
1.4 (1.0,2.1) 4.1* (1.7,10.1) 4.4* (1.8,10.7) 2.5* (1.6,3.8) 2.0* (1.1,3.6)
Prostate disease
1.8* (0.8,3.7) 2.0* (1.1,3.6)
1.5 (0.8,2.9) 1.9 (0.7,5.6)
2.2 (0.5,9.6)
1.3 (0.7,2.5)
1.8 (0.4,8.9)
Smoking
Never
Referent
Referent
Referent
Referent
Referent
Referent
Referent
Smoked before
1.2 (0.7,2.2)
0.8 (0.5,1.3)
0.9 (0.6,1.5) 1.0 (0.4,2.7)
0.5 (0.1,1.6)
0.9 (0.5,1.7)
0.7 (0.3,1.8)
w
Currently smoking
1.1 (0.6,2.0)
1.1 (0.6,1.7)
1.5 (0.9,2.5) 1.4 (0.6,3.4)
0.4 (0.2,1.1)
1.1 (0.7,1.9)
1.0 (0.5,2.0)
Thinking of sex
Never or o1/month
Referent
Referent
Referent
Referent
Referent
Referent
Referent
A few times/month
3.9 (0.7,20.7) 1.3 (0.6,2.7)
0.6 (0.3,1.4) 0.2* (0.1,0.5)
1.7 (0.3,8.3)
1.1 (0.6,1.9)
1.6 (0.5,4.5)
A few times/week
2.3 (0.4,13.3) 1.3 (0.5,3.2)
0.5 (0.2,1.2) 0.1* (0.0,0.4)
1.2 (0.2,6.5)
2.2 (0.8,6.0)
0.9 (0.2,3.1)
Belief that aging reduces
0.8 (0.5,1.4)
1.0 (0.7,1.6)
1.2 (0.8,1.9) 0.9 (0.4,2.1)
1.3 (0.6,3.0)
1.1 (0.7,1.7)
1.0 (0.6,1.9)
sex energy
Education
At least some college
Referent
Referent
Referent
Referent
Referent
Referent
Referent
Secondary/high school
1.0 (0.5,1.9)
1.1 (0.6,1.7)
1.2 (0.8,1.9) 1.4 (0.5,3.9)
2.0 (0.6,6.6)
1.0 (0.6,1.6)
0.9 (0.5,1.8)
Primary school or less
0.5 (0.2,1.3)
0.8 (0.5,1.4)
1.1 (0.5,2.6) 1.8 (0.7,4.8)
1.0 (0.3,3.0)
1.6 (0.8,2.9)
0.4 (0.1,1.6)
Belief in religion guiding sex
1.2 (0.7,2.2)
0.9 (0.6,1.4)
0.8 (0.5,1.3) 0.9 (0.4,2.1)
1.7 (0.6,4.4)
1.4 (0.5,4.0)
0.9 (0.5,1.9)
w
Divorce in past 3 y
0.5 (0.1,4.0)
0.5 (0.2,1.4) 0.3* (0.1,1.0)
n.a.
2.0 (0.4,8.9)
2.7 (0.4,17.3) 4.8 (0.8,29.2)
w
Financial problems in last 3 y
2.3* (1.0,5.0)
1.6 (0.9,2.7)
1.4 (0.8,2.4) 2.0 (0.9,4.2) 3.1* (1.3,7.3)
0.9 (0.5,1.6) 2.2* (1.2,4.1)
Depression diagnosed
1.1 (0.5,2.4) 1.9* (1.1,3.1) 1.9* (1.1,3.3) 2.0 (0.7,5.4)
1.9 (0.4,8.6)
1.5 (0.3,7.4)
0.8 (0.2,2.4)
Partnership status
Exclusive and committed
Referent
Referent
Referent
Referent
Referent
Referent
Referent
Exclusive but not committed 1.5 (0.6,3.7) 3.1* (1.7,5.8) 2.2* (1.2,3.8) 0.7 (0.1,3.6)
n.a.
0.7 (0.1,7.3) 6.7* (1.1,41.8)
Nonexclusive
1.3 (0.4,4.2) 1.9* (1.0,3.6) 3.1* (1.0,9.1) 0.9 (0.3,3.0)
1.3 (0.4,4.5)
1.3 (0.6,2.8)
1.1 (0.4,2.6)
Future of the relationship
High hope
Referent
Referent
Referent
Referent
Referent
Referent
Referent
w
Worried
0.5 (0.1,2.4)
1.0 (0.4,2.2)
1.4 (0.6,3.2) 0.5 (0.1,2.2)
4.3 (0.7,25.1) 1.2 (0.4,3.5)
4.2 (0.8,22.0)
w
No future
0.8 (0.3,2.4)
0.8 (0.4,1.7)
1.4 (0.6,3.4) 1.1 (0.3,3.8)
4.3 (0.8,23.1) 3.1 (0.9,10.9) 0.7 (0.1,7.4)
Frequency of sexual relationship
Several times per week
Referent
Referent
Referent
Referent
Referent
Referent
Referent
w
w
2 to 3 times per month
2.0* (1.2,3.5)
1.4 (1.0,2.2) 2.3* (1.5,3.6) 1.5 (0.7,3.3)
1.0 (0.3,3.1)
1.0 (0.5,2.1)
1.8 (1.0,3.5)
Less than monthly
5.7* (2.6,12.5) 3.3* (1.8,6.1) 3.2* (1.8,5.6) 3.6* (1.0,13.1) 8.6* (1.5,48.9) 1.8 (0.8,4.1) 2.8* (1.0,7.6)
w
Usually does not engage
0.5 (0.2,1.2)
0.8 (0.5,1.4)
1.7 (0.9,3.3) 1.0 (0.3,3.5)
0.5 (0.1,1.7)
1.0 (0.6,1.6)
0.9 (0.4,2.1)
in foreplay
w2
159.5
144.8
163.5
81.6
80.7
124.4
89.5
d.f.
30
28
28
25
25
28
27
Observations
1402
1879
1447
520
705
1101
566
Odds ratios from logistic regression. Based on reports from sexually active men. Country differences in each region controlled.
Northern Europe includes Austria, Belgium, Sweden, and Germany.
Southern Europe includes France, Israel, Italy, and Spain.
Non-European West includes Australia, Canada, New Zealand, and the US.
Central/South America includes Brazil and Mexico.
Middle East includes Egypt and Turkey.
East Asia includes China, Hong Kong, Taiwan, and Japan.
Southeast Asia includes Indonesia, Philippines, and Singapore.
w
*Pr0.05; Pr0.10.
International Journal of Impotence Research

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