Comments: Longitudinal study surveying males and females over a 2-year period. Results reveal astronomical rates of sexual problems in males ages 16-21:
- low sexual satisfaction (47.9%)
- low desire (46.2%)
- problems in erectile function (45.3%)
The paper notes that males traditionally report far lower rates of sexual problems than female, yet this wasn’t the case with adolescents.
“Striking is the lack of sex difference in the rates reported here; it varies notably from the adult literature which consistently reveals higher rates among women than men [12,13].”
While females’ sexual problems improved over time the males’ sexual problems did not:
“Unlike for male adolescents, we found a clearer picture of improvement over time for female adolescents, suggesting that learning and experience played a role in improving their sexual lives.”
Finally, not being in a sexual relationship was the only factor significantly related to sexual problems (to participate in this survey one must have engaged in sex in the preceding 4 weeks).
“A primary aim was to assess factors useful for identifying who was most likely to report a sexual problem over time. The only factor that emerged as a strong predictor was relationship status: Adolescents who were not in a sexual relationship were approximately three times more likely to report a problem in sexual functioning compared to those who were in a sexual relationship.”
For males being single is related to more internet porn use. Were the higher rates of sexual problems in single people related to greater porn use? Were the high rates over all related to internet porn use (which typically starts well before actual sex)? It’s important to note sexual dysfunction rates are always higher in sexually inactive populations. In other words, the rates would be even higher if sexually inactive adolescents were included.
J Adolesc Health. 2016 Jun 16. pii: S1054-139X(16)30056-8. doi: 10.1016/j.jadohealth.2016.05.001.
O’Sullivan LF1, Byers ES2, Brotto LA3, Majerovich JA4, Fletcher J5.
Abstract
PURPOSE:
Rates of sexual dysfunctions are high among adults, but little is known about problems in sexual functioning among adolescents. We completed a comprehensive assessment of problems in sexual functioning and related distress over a 2-year period among adolescents (16-21 years).
METHODS:
A sample of 405 adolescents completed five online surveys over 2 years. The main outcome measures were clinical cutoff scores on the International Index of Erectile Function and Premature Ejaculation Diagnostic Tool for male adolescents and the Female Sexual Function Index for female adolescents. A secondary outcome was clinical levels of distress.
RESULTS:
The majority of sexually active adolescents (78.6% of the male and 84.4% of the female) reported a sexual problem over the course; rates did not differ significantly by gender. Common problems for males were low sexual satisfaction (47.9%), low desire (46.2%), and problems in erectile function (45.3%). Common problems for females were inability to reach orgasm (59.2%), low satisfaction (48.3%), and pain (46.9%). Models predicting problems over time showed increased odds among those not in a sexual relationship. Odds of reporting a distressing sexual problem decreased over time for female but not male adolescents.
CONCLUSIONS:
Problems in sexual functioning emerge early in individuals’ sexual lives, are often distressing, and appear not to fluctuate over time. Additional efforts to identify key factors linked to onset will help elucidate possible mechanisms.
KEYWORDS:
Adolescents; Female sexual dysfunction; Longitudinal study; Male sexual dysfunction; Sexual distress; Sexual function; Sexual health; Sexual problems; Sexual relationships; Sexual self-esteem
PMID: 27320034
DOI: 10.1016/j.jadohealth.2016.05.001
Discussion
We report the first data to our knowledge tracking problems in sexual functioning among a nonclinical sample of middle to late adolescents. Approximately 80% of the sexually active adolescents reported a sexual problem over the 2 years of assessments, and almost half of these problems reached clinically significant levels of distress (using adult metrics). As reported in an earlier study incorporating qualitative interviews [9], these problems can have a profound negative impact on individual and relationship functioning. Striking is the lack of sex difference in the rates reported here; it varies notably from the adult literature which consistently reveals higher rates among women than men [12,13]. It may be that male adolescents’ problems are resolved over time or that female adolescents experience an upsurge that accounts for this divergence in adult rates. What is clear is that the early sexual lives for many start out characterized by problems in sexual functioning that might warrant clinical diagnosis as dysfunctions in the future.
Difficulty getting and/or maintaining an erection was reported most often among the male adolescents. Low sexual self-esteem was linked to slightly higher odds of reporting a sexual problem as well as a distressing sexual problem for adolescents. This finding might reflect repeated unsuccessful attempts to engage in sexual activity after consuming alcohol; the pairing of heavy drinking and sexual activity among adolescents is well documented [37]. Somewhat surprising was the fairly high rates of no/ low sexual satisfaction and desire among male adolescents, although both erection problems and lacking desire are common among adult men and increase steadily over time [13]. These rates support research demonstrating that a notable minority of young men comply with unwanted (although not necessarily coerced) sexual activity [38]. In support of this argument was the finding that endorsement of more traditional beliefs about men’s sexual roles (e.g., “A real man is always ready for sex”) identified male adolescents at somewhat higher risk for problems. Future research should explore endorsement of beliefs or social norms might contribute to dysfunction
Female adolescents reported difficulty in climaxing, as well as no/little sexual desire and satisfaction most frequently. These problems parallel those found at high levels among adult women [12,13,39]. Higher sexual self-esteem was linked to lower risk of a sexual problem, including distressing problems, as was communicating one’s likes and dislikes sexually, but only by a small margin. Unlike for male adolescents, we found a clearer picture of improvement over time for female adolescents, suggesting that learning and experience played a role in improving their sexual lives. Coercion histories increased odds of a problem in functioning among female adolescents, as found among women [21].
A primary aim was to assess factors useful for identifying who was most likely to report a sexual problem over time. The only factor that emerged as a strong predictor was relationship status: Adolescents who were not in a sexual relationship were approximately three times more likely to report a problem in sexual functioning compared to those who were in a sexual relationship. Relationship status did not predict reports of distressing sexual problems, however. These findings suggest that adolescents avoid connecting intimately with others when experiencing sexual problems, or possibly, those in relationships have opportunities to discuss and improve their sexual functioning in ways not possible for those who are single. Further research is needed to examine this association in greater detail.
Study limitations include assessing sexual problems within prior 4 weeks of each assessment, although in line with how sexual dysfunctions are assessed among adults. Rates would likely be higher with more frequent, broader assessments. We did not assess for general health status or chronic diseases (e.g., diabetes mellitus), nor the contexts of our respondents’ lives (e.g., school, family, work), which are known to affect risk of problems in sexual function [40]. The sample was fairly homogenous, limiting generalizability to more diverse groups. Reliance on self-reports introduces problems of recall bias, and social desirability factors inherent to studies using such methods. A strength of the study has been the use of comprehensive, widely adopted measures of sexual dysfunction, which will allow other researchers to compare the rates obtained here to adult samples. Formal validation work is still needed, however.
Finally, the longitudinal design facilitates some of the first insights into the onset and progression of problems in sexual functioning as adolescents make the transition into adulthood, but does not permit conclusions about causality. Health care providers and clinicians need to inquire about sexual functioning when adolescents present with related issues and establish open communication about sexual matters as much as possible. Pleasure is a key component to healthy sexual development. Healthy sexual development can be encouraged through the processes of learning, communication, and experimentation key to discerning what is pleasurable in one’s sexual life and in one’s interactions with partners, as well as the contexts and circumstances that are most conducive to positive encounters.
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