Sexual desire, erection, orgasm and ejaculatory functions and their importance to elderly Swedish men: a population-based study

Age and Ageing,  July, 1996  by Asgeir R. Helgason,  Jan Adolfsson,  Paul Dickman,  Stefan Arver,  Mats Fredrikson,  Marianne Gothberg,  Gunnar Steineck

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Key words: Sexual function, Distress, Elderly men.

Background

Since the establishment of the Swedish Association for Sex Education in 1933 and the introduction of more liberal laws regarding sexuality and compulsory sex education in schools in 1955, Sweden has experienced an increasingly relaxed attitude towards sex. These factors, accompanied by intensified exposure of sexual issues in the media, have resulted in a demand from patients and patient organizations to include assessment of sexual function in clinical care. Three population-based studies have been published in which a few aspects of sexual function have been assessed in elderly men [1-3]. The study on sexual function recently published in the USA did not assess the sex life of people over 59 years of age [4] and no population-based study has analysed the relationship between different aspects of sexual function and its importance to elderly men. It is therefore difficult to estimate how different diseases and their treatment affect sexuality in this patient group and to what extent diminished sexual function distresses the patients. Several studies indicate that elderly men continue to be sexually active throughout their lives. Masters and Johnson found no upper age limit for sexual function [5]. Pfeiffer stated that about 70% of men with an average age of 68 'regularly partake in sexual activity' [6]. Persson reported that 52% of 70-year-old married men still engaged in intercourse and roughly 20% more often than once a month [1]. Helgason et al. [7] found that most men (median age 70 years) were distressed when external beam radiation therapy for localized prostate cancer decreased sexual function. This was true of all aspects of sexuality assessed: sexual desire, erection and orgasm.

The aim of the present study was to obtain basic information on sexual desire, erection, orgasm and ejaculatory functions and to assess to what extent a decline in function distresses elderly men. The data may be used in clinical decision-making and in the design of clinical trials for diseases affecting elderly men, such as prostate cancer and diabetes mellitus.

Subjects and Methods

A questionnaire was mailed to 195 men aged 70-80 years, 155 men aged 60-69 and 85 men aged 50-59, randomly selected from Stockholm residents from the Swedish Population Registry. This is made possible by the Swedish civil registration system, in which each citizen is given a unique identification number and all citizens are entered into a computerized population registry. The study was approved by the local ethics committee.

A letter introducing and explaining the aims of the study was sent to all men before they received the questionnaire. The survey was anonymous but the men were asked to supply their name on a special form and return it separately when they had completed the questionnaire. This was done in order to identify those who did not respond. Non-respondents received two reminding letters and finally, if possible, a telephone call, assessing the reason for non-response. The collection of data started in October 1993, and was completed in April 1994.

The questionnaire comprised over 140 questions, including Radiumhemmet's Scale of Sexual Function and questions assessing potential risk factors for decreased sexual function. Radiumhemmet's Scale of Sexual Function was developed during successive in-depth interviews with over 30 patients and has been judged by several clinicians to reflect the clinical interview accurately. It contains 40 questions using from five to eight ordinal categories as response alternatives and assesses three global phases of sexuality: desire, erection and orgasm. Each aspect of sexuality is evaluated with separate questions measuring frequency and/or intensity. Distress due to decreased function is assessed for all aspects of sexual function. The questionnaire is designed so that all men can relate to all questions, regardless of sexual preference.

The modules designed to assess different aspects of sexual desire include questions on frequency of sexual dreams, frequency of sexual thoughts or desires of any kind and the overall importance of sexuality. Erection is assessed using questions about the frequency of sexually stimulated erections, morning erections and spontaneous erections. Erection stiffness for all three aspects of erection is compared to erections in youth. In the present analysis, potency was defined as erection stiffness 'usually sufficient for intercourse'. Potency in any of the three stiffness domains w as defined as 'physiological potency' (Table I). Finally, erection maintenance during intercourse and/or masturbation is assessed. Questions about orgasm frequency, orgasmic pleasure, and ejaculate volume capture different aspects of orgasm. The importance of an intact sexual function is assessed for different aspects of sexuality and the importance of regaining a previous level of performance is assessed in case of decreased function. Additional questions assessing frequency of intercourse and sexual initiatives are also included.