Sexual function in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).
Sexual function in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).
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DOI：
10.1016/s0140-6736(13)62366-1
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发表时间：
2013-11-30
期刊：
影响因子：
168.9
通讯作者：
Wellings, Kaye
中科院分区：
文献类型：
--
作者：
Mitchell, Kirstin R.;Mercer, Catherine H.;Ploubidis, George B.;Jones, Kyle G.;Datta, Jessica;Field, Nigel;Copas, Andrew J.;Tanton, Clare;Erens, Bob;Sonnenberg, Pam;Clifton, Soazig;Macdowall, Wendy;Phelps, Andrew;Johnson, Anne M.;Wellings, Kaye
尽管性功能对性健康和幸福很重要，但在性健康政策中却很少受到关注。需要以人群为基础的研究来了解整个生命过程中的性功能。我们对居住在英国（英格兰、苏格兰和威尔士）年龄在16-74岁之间的15162人进行了概率抽样调查（第三次国家性态度和生活方式调查[Natsal-3]）。访谈时间为2010年9月6日至2012年8月31日。我们通过使用一种新的有效的测量方法（Natsal-SF）来评估性功能的分布，该方法评估了个体性反应、两性关系中的性功能和对性生活的自我评价（17个项目，每个性别16个项目）。我们评估了与性功能低下相关的因素（定义为Natsal-SF分数分布的最低五分位数）和测量成分的分布。报告在过去一年中有一个或多个性伴侣的参与者在Natsal-SF（11690名参与者）上得到一个分数。这些参与者中有4122人在过去的一年中都没有关系，我们采用了全信息最大似然法来处理四个关系项目上的缺失数据。我们为Natsal-SF获得了4913名男性和6777名女性的数据。在男性和女性中，性功能低下与年龄增加有关，年龄调整后与抑郁相关（男性校正优势比为3.70 [95% CI 2.90 - 4.72]，女性校正优势比为4.11[3.36 - 5.04]），自我报告健康状况不佳（2.63[1.73 - 3.98]和2.41[1.72 - 3.39]）。性功能低下还与经历一段关系的结束（1.52[1.18 - 1·95]和1.77[1.44 - 2·17]）、无法与伴侣轻松谈论性（2.36[1.94 - 2·88]和2.82[2.28 - 3.48]）以及在关系中不快乐（2.89[2.32 - 3·61]和4.10[3.39 - 4.97]）有关。在过去4周内从事少于4次性行为（3.13次[2.58 - 3.79]和3.38次[2.80 - 4.09]），有同性伴侣（2.28次[1.56 - 3.35]和1.60次[1.16 - 2.20]），支付性费用（仅限男性；2.62次[1.46 - 4.71]），以及终生性伴侣数量较多（仅限女性；2.12次[1.68 - 2.67]）。性功能低下还与非自愿性行为经历（1.98[1.14 - 3.43]和2.18[1.79 - 2.66]）和性传播感染诊断（1.50[1.06 - 2.11]和1.83[1.35 - 2.47]）等负面性健康结果相关。在过去一年中报告性生活的个人中，性反应问题很常见（41.6%的男性和51.2%的女性报告了一个或多个问题），但自我报告性生活困扰的情况要少得多（9.9%和10.9%）。在过去一年中，有性关系的个人中，23.4%的男性和27.4%的女性报告伴侣之间的性兴趣水平不平衡，18.0%的男性和17.1%的女性表示他们的伴侣有性困难。大多数在过去一年中没有性生活的参与者并没有因为性生活困难而感到不满、苦恼或避免性生活。性功能评分的分布存在很大的变异性。性功能低下与负面的性健康结果有关，这支持了在性健康政策和干预措施中更加强调性功能的呼吁。英国医学研究理事会和威康信托基金资助，经济和社会研究理事会和卫生部支持。
Despite its importance to sexual health and wellbeing, sexual function is given little attention in sexual health policy. Population-based studies are needed to understand sexual function across the life course. We undertook a probability sample survey (the third National Survey of Sexual Attitudes and Lifestyles [Natsal-3]) of 15 162 individuals aged 16–74 years who lived in Britain (England, Scotland, and Wales). Interviews were done between Sept 6, 2010, and Aug 31, 2012. We assessed the distribution of sexual function by use of a novel validated measure (the Natsal-SF), which assessed problems with individual sexual response, sexual function in a relationship context, and self-appraisal of sex life (17 items; 16 items per gender). We assess factors associated with low sexual function (defined as the lowest quintile of distribution of Natsal-SF scores) and the distribution of components of the measure. Participants reporting one or more sexual partner in the past year were given a score on the Natsal-SF (11 690 participants). 4122 of these participants were not in a relationship for all of the past year and we employed the full information maximum likelihood method to handle missing data on four relationship items. We obtained data for 4913 men and 6777 women for the Natsal-SF. For men and women, low sexual function was associated with increased age, and, after age-adjustment, with depression (adjusted odds ratio 3·70 [95% CI 2·90–4·72] for men and 4·11 [3·36–5·04] for women) and self-reported poor health status (2·63 [1·73–3·98] and 2·41 [1·72–3·39]). Low sexual function was also associated with experiencing the end of a relationship (1·52 [1·18–1·95] and 1·77 [1·44–2·17]), inability to talk easily about sex with a partner (2·36 [1·94–2·88] and 2·82 [2·28–3·48]), and not being happy in the relationship (2·89 [2·32–3·61] and 4·10 [3·39–4·97]). Associations were also noted with engaging in fewer than four sex acts in the past 4 weeks (3·13 [2·58–3·79] and 3·38 [2·80–4·09]), having had same sex partners (2·28 [1·56–3·35] and 1·60 [1·16–2·20]), paying for sex (in men only; 2·62 [1·46–4·71]), and higher numbers of lifetime sexual partners (in women only; 2·12 [1·68–2·67] for ten or more partners). Low sexual function was also associated with negative sexual health outcomes such as experience of non-volitional sex (1·98 [1·14–3·43] and 2·18 [1·79–2·66]) and STI diagnosis (1·50 [1·06–2·11] and 1·83 [1·35–2·47]). Among individuals reporting sex in the past year, problems with sexual response were common (41·6% of men and 51·2% of women reported one or more problem) but self-reported distress about sex lives was much less common (9·9% and 10·9%). For individuals in a sexual relationship for the past year, 23·4% of men and 27·4% of women reported an imbalance in level of interest in sex between partners, and 18·0% of men and 17·1% of women said that their partner had had sexual difficulties. Most participants who did not have sex in the past year were not dissatisfied, distressed, or avoiding sex because of sexual difficulties. Wide variability exists in the distribution of sexual function scores. Low sexual function is associated with negative sexual health outcomes, supporting calls for a greater emphasis on sexual function in sexual health policy and interventions. Grants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health.