Epidemiology

The first detailed survey, by Kinsey and his colleagues in the 1940s,(23) left several unanswered questions. In this survey, 12 000 male volunteers were interviewed, some on many occasions (50 000 h of interviews). The source of the volunteers is never revealed. (Maslow and Sakoda (4) discuss these issues.) However, from the point of view of this chapter it is disappointing that the sample included only 26 males and 10 females over the age of 70. The authors' conclusion that 75 per cent of males were impotent by the age of 75 was based on a sample of four. Surprisingly, it has never been challenged.

Wellings et al.(5) restricted their sample to people below 60 years of age. They reported a decline in sexual activity with age; the median frequency of coitus per four weeks was 7 at age 20, 5 at age 40, and 3 in the fifties.

Janus and Janus(6) surveyed 2765 subjects in the United States by questionnaire (the response rate was only 61 per cent), supplemented by 125 interviews. They found less reduction of activity in the older groups than had been found in earlier surveys, probably because they did not confine the question to coitus ( Table 1). In every age group men thought that they were more active than 3 years previously, but women, particularly those over 50, noted a decline. Unlike earlier studies foreplay was discussed, and the authors concluded that older men gain greater pleasure and experience more intimacy and warmth after coitus than younger men. There was no evidence that older people were more conservative in their attitudes: 39 per cent supported the statement that 'traditional sex roles have no place in modern society' compared with 27 per cent of males and 31 per cent of females aged between 18 and 26. They concluded that 'because of increased acceptance and participation in sex matters it is no longer possible to predict with any accuracy the type and frequency of sexual experiences of individuals simply by age'.

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Table 1 Frequency of all sexual activity

Osborn et al.{D assessed sexual dysfunction in 436 women aged 35 to 59 with partners by interview (Tabled). All dysfunction increased with age, except vaginal dryness which reached its maximum just after the menopause. Although the older women had more operationally defined sexual dysfunction they were less likely to recognize it as such. Some of the anorgasmia of older women may be a cohort effect.

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